Individual
MANUEL HECTOR HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2484 CARING WAY, SUITE C, PORT CHARLOTTE, FL 33952-5306
(941) 764-7773
Mailing address
PO BOX 510065, PUNTA GORDA, FL 33951-0065
(941) 764-7773
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0076069
FL
207ND0101X
MOHS-Micrographic Surgery Physician
0076069
FL
207ND0900X
Dermatopathology Physician
0076069
FL
207NP0225X
Pediatric Dermatology Physician
0076069
FL
207NS0135X
Procedural Dermatology Physician
0076069
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44353
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/17/2007
Last updated
05/15/2008
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