Healthcare Provider Details

I. General information

NPI: 1891765459
Provider Name (Legal Business Name): ALFRED D. HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 S OSPREY AVE
SARASOTA FL
34239-3614
US

IV. Provider business mailing address

1849 S OSPREY AVE
SARASOTA FL
34239-3614
US

V. Phone/Fax

Practice location:
  • Phone: 941-957-4767
  • Fax: 941-955-7334
Mailing address:
  • Phone: 941-957-4767
  • Fax: 941-955-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME45255
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME45255
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME45255
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME45255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: