Basic Information
| Provider Information | |||||||||
| NPI: | 1568755221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MARLOW | ||||||||
| MiddleName: | BLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545386868 | ||||||||
| FaxNumber: | 9545386850 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545386868 | ||||||||
| FaxNumber: | 9545386850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 202K00000X | OS11834 | FL | N | Allopathic & Osteopathic Physicians | Phlebology | 208D00000X | OS11834 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207R00000X | OS11834 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 2086S0129X | OS11834 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 007150400 | 05 | FL | MEDICAID |