Healthcare Provider Details

I. General information

NPI: 1619904562
Provider Name (Legal Business Name): LAZARO ANDRES HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 W M L KING BLVD SUITE 1
TAMPA FL
33607
US

IV. Provider business mailing address

2309 W M L KING BLVD SUITE 1
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-2778
  • Fax: 813-877-6761
Mailing address:
  • Phone: 813-879-2778
  • Fax: 813-877-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME019886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: