Provider Demographics
NPI:1568755221
Name:HERNANDEZ, MARLOW BLAS (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:MARLOW
Middle Name:BLAS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10608 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5512
Mailing Address - Country:US
Mailing Address - Phone:954-448-3647
Mailing Address - Fax:
Practice Address - Street 1:3399 NW 72ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1355
Practice Address - Country:US
Practice Address - Phone:786-698-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2025-01-15
Deactivation Date:2024-12-10
Deactivation Code:
Reactivation Date:2025-01-09
Provider Licenses
StateLicense IDTaxonomies
FLOS11834202K00000X, 208D00000X, 207R00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007150400Medicaid
NV250010110Medicaid