Healthcare Provider Details

I. General information

NPI: 1205078649
Provider Name (Legal Business Name): LUIS OSCAR HERNANDEZ III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 SW 87TH AVENUE 212
MIAMI FL
33173
US

IV. Provider business mailing address

9500 S DADELAND BLVD 200
MIAMI FL
33156
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-3080
  • Fax: 305-596-3073
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-596-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTRN 13872
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME124589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: