Basic Information
| Provider Information | |||||||||
| NPI: | 1679538797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRION | ||||||||
| FirstName: | HERNAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9165 PARK DR | ||||||||
| Address2: | |||||||||
| City: | MIAMI SHORES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331383163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055456685 | ||||||||
| FaxNumber: | 7865150254 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 NW 14TH ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055472534 | ||||||||
| FaxNumber: | 3053267210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | ME20544 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 053422600 | 05 | FL | MEDICAID | 10D0877365 | 01 | FL | CLIA NUMBER | OTHER |