Provider Demographics
NPI:1699739565
Name:HERNANDEZ, ADAN LAZARO (MD)
Entity type:Individual
Prefix:DR
First Name:ADAN
Middle Name:LAZARO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3516
Mailing Address - Country:US
Mailing Address - Phone:954-893-8900
Mailing Address - Fax:954-416-6633
Practice Address - Street 1:4510 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3516
Practice Address - Country:US
Practice Address - Phone:954-893-8900
Practice Address - Fax:954-416-6633
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72539207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
43395OtherBCBS
TX2020647OtherAETNA
UT59-2466190OtherUNITED HEALTHCARE INS.
FL592466190OtherMEMORIAL PRIMARY
592466190OtherTRICARE
9950513-001OtherCIGNA HEALTHCARE
FL028093OtherNEIGHBORHOOD HEALTH PLAN
FL171586OtherJMH
FL303143OtherAVMED
FLG914OtherSUMMIT
FL254674400Medicaid
FL59-2466190OtherMEMORIAL MANAGED CARE
FLG69397OtherVISTA HEALTH PLAN
FL43395Medicare PIN
43395OtherBCBS
FL171586OtherJMH