MEDICARE: DR. RICHARD E HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME0043730	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235104167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD E HERNANDEZ

Provider Business Mailing Address
First Line	:	PO BOX 560130
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33256-0130
Country	:	US
Telephone Number	:	305-360-9244
Fax Number	:	305-630-9223

Provider Business Practice Location Address
First Line	:	7765 SW 87TH AVE
Second Line	:	SUITE 105
City	:	MIAMI
State	:	FL
Zip	:	33173-2596
Country	:	US
Telephone Number	:	305-274-0808
Fax Number	:	305-274-8311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/27/2020

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Directions to “ DR. RICHARD E HERNANDEZ ” Practice Location

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