{"id":2167,"date":"2025-03-26T11:06:38","date_gmt":"2025-03-26T15:06:38","guid":{"rendered":"https:\/\/primarycaredoctormiami.com\/old\/?p=2167"},"modified":"2025-03-26T11:06:38","modified_gmt":"2025-03-26T15:06:38","slug":"onychogryphosis-in-miami","status":"publish","type":"post","link":"https:\/\/primarycaredoctormiami.com\/old\/onychogryphosis-in-miami\/","title":{"rendered":"Onychogryphosis: Understanding Ram&#8217;s Horn Nails"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:30px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:15px;margin-bottom:15px;width:100%;\"><div class=\"fusion-separator-border sep-single\" style=\"--awb-height:20px;--awb-amount:20px;border-color:hsla(var(--awb-color3-h),calc( var(--awb-color3-s) + 3% ),var(--awb-color3-l),var(--awb-color3-a));border-top-width:1px;\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-background-position:left top;--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:100px;--awb-padding-bottom:75px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-padding-top:0px;--awb-padding-right:40px;--awb-padding-bottom:0px;--awb-padding-left:40px;--awb-bg-color:var(--awb-color1);--awb-bg-color-hover:var(--awb-color1);--awb-bg-size:cover;--awb-border-color:var(--awb-color3);--awb-border-top:0px;--awb-border-right:0px;--awb-border-bottom:0px;--awb-border-left:0px;--awb-border-style:solid;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:30px;--awb-spacing-left-large:2.88%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-one\" style=\"--awb-margin-bottom:30px;\"><h1 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:capitalize;--fontSize:48;line-height:var(--awb-typography1-line-height);\"><h1><span style=\"font-weight: 400;\">Onychogryphosis: Understanding Ram&#8217;s Horn Nails<\/span><\/h1><\/h1><\/div><div class=\"fusion-image-element \" style=\"--awb-margin-top:-15px;--awb-margin-bottom:20px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\" style=\"border:1px solid var(--awb-color2);border-radius:10px;\"><img decoding=\"async\" width=\"1200\" height=\"899\" alt=\"onychogryphosis example\" title=\"onychogryphosis\" src=\"https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis.webp\" data-orig-src=\"https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis.webp\" class=\"lazyload img-responsive wp-image-2168\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%271200%27%20height%3D%27899%27%20viewBox%3D%270%200%201200%20899%27%3E%3Crect%20width%3D%271200%27%20height%3D%27899%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-200x150.webp 200w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-300x225.webp 300w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-400x300.webp 400w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-600x450.webp 600w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-768x575.webp 768w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-800x599.webp 800w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis-1024x767.webp 1024w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/onychogryphosis.webp 1200w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 800px\" \/><\/span><\/div><div class=\"fusion-text fusion-text-1\"><p><span style=\"font-weight: 400;\">Onychogryphosis, commonly known as ram&#8217;s horn nails, is a nail disorder characterized by thickened, curved, and often discolored nails. This condition can cause significant discomfort and impact quality of life. In Miami, understanding onychogryphosis and seeking timely medical attention is crucial for effective management.\u00a0\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">What is Onychogryphosis? A Nail Disorder Explained<\/span><\/h3>\n<p><b>Onychogryphosis<\/b><span style=\"font-weight: 400;\"> is a hypertrophy of the nails, typically affecting the toenails, although it can also occur in fingernails. The nails become thickened, elongated, and curved, resembling a ram&#8217;s horn.\u00a0\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Causes of Onychogryphosis: Factors Contributing to the Condition<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Several factors can contribute to the development of onychogryphosis:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Trauma:<\/b><span style=\"font-weight: 400;\"> Repeated injury to the nail bed can lead to abnormal nail growth.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Aging:<\/b><span style=\"font-weight: 400;\"> Natural nail growth slows and thickens with age, increasing susceptibility.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Poor Circulation:<\/b><span style=\"font-weight: 400;\"> Conditions like <\/span><a href=\"https:\/\/primarycaredoctormiami.com\/old\/make-appointment\/\"><span style=\"font-weight: 400;\">peripheral artery disease<\/span><\/a><span style=\"font-weight: 400;\"> can impair blood flow to the extremities.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Fungal Infections:<\/b><span style=\"font-weight: 400;\"> Chronic fungal infections can contribute to nail thickening and discoloration.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Psoriasis:<\/b><span style=\"font-weight: 400;\"> This skin condition can affect nail growth.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Genetic Predisposition:<\/b><span style=\"font-weight: 400;\"> In some cases, onychogryphosis may be inherited.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Neglected Nail Care:<\/b><span style=\"font-weight: 400;\"> Infrequent trimming or improper nail care can worsen the condition.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<h4><span style=\"font-weight: 400;\">Discolored Toenail: Recognizing the Visual Changes<\/span><\/h4>\n<p><b>Discolored toenail<\/b><span style=\"font-weight: 400;\"> is a common symptom of onychogryphosis. Nails can appear yellow, brown, or even black due to thickening, debris buildup, or fungal infections.\u00a0\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Black Toenail: Distinguishing Between Causes<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A <\/span><b>black toenail<\/b><span style=\"font-weight: 400;\"> can result from various factors, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Subungual Hematoma:<\/b><span style=\"font-weight: 400;\"> Blood trapped under the nail due to trauma.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Fungal Infection:<\/b> <a href=\"https:\/\/primarycaredoctormiami.com\/old\/make-appointment\/\"><span style=\"font-weight: 400;\">Fungal infections<\/span><\/a><span style=\"font-weight: 400;\"> can cause darkening of the nail.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Onychogryphosis:<\/b><span style=\"font-weight: 400;\"> The thickening and discoloration associated with onychogryphosis can result in a black appearance.<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Black Toenail Fungus: A Common Culprit<\/span><\/h3>\n<p><b>Black toenail fungus<\/b><span style=\"font-weight: 400;\"> can contribute to nail discoloration and thickening. It&#8217;s crucial to differentiate between fungal infections and other causes of black toenails.<\/span><\/p>\n<\/div><div class=\"fusion-image-element \" style=\"--awb-margin-top:15px;--awb-margin-bottom:20px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\" style=\"border:1px solid var(--awb-color2);border-radius:10px;\"><img decoding=\"async\" width=\"1200\" height=\"801\" alt=\"nail mold vs fungus\" title=\"nail-mold-vs-fungus\" src=\"https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus.webp\" data-orig-src=\"https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus.webp\" class=\"lazyload img-responsive wp-image-2169\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%271200%27%20height%3D%27801%27%20viewBox%3D%270%200%201200%20801%27%3E%3Crect%20width%3D%271200%27%20height%3D%27801%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-200x134.webp 200w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-300x200.webp 300w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-400x267.webp 400w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-600x401.webp 600w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-768x513.webp 768w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-800x534.webp 800w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus-1024x684.webp 1024w, https:\/\/primarycaredoctormiami.com\/old\/wp-content\/uploads\/2025\/03\/nail-mold-vs-fungus.webp 1200w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 800px\" \/><\/span><\/div><div class=\"fusion-text fusion-text-2\"><h4><span style=\"font-weight: 400;\">Nail Mold vs Fungus: Understanding the Difference<\/span><\/h4>\n<p><b>Nail mold vs fungus<\/b><span style=\"font-weight: 400;\"> can be difficult to distinguish. Both can cause nail discoloration and changes. However, mold typically affects the surface of the nail, while fungus penetrates deeper.\u00a0\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Symptoms of Onychogryphosis: Identifying the Signs<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Thickened and elongated nails.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Curved, ram&#8217;s horn-like appearance.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Discoloration (yellow, brown, black).\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pain or discomfort, especially with pressure.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Difficulty trimming nails.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ingrown nails.<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Treatment Options for Onychogryphosis: Addressing the Condition<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Treatment for onychogryphosis depends on the severity and underlying cause:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Regular Nail Trimming:<\/b><span style=\"font-weight: 400;\"> Professional nail trimming by a podiatrist is essential.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Nail Softening Agents:<\/b><span style=\"font-weight: 400;\"> Topical medications can soften the nails, making them easier to trim.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Oral or Topical Antifungal Medications:<\/b><span style=\"font-weight: 400;\"> For fungal infections.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Nail Avulsion:<\/b><span style=\"font-weight: 400;\"> In severe cases, surgical removal of the nail may be necessary.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Treatment of Underlying Conditions:<\/b><span style=\"font-weight: 400;\"> Addressing conditions like poor circulation or psoriasis.<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Primary Doctor in Miami: Your First Step to Nail Health<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you&#8217;re experiencing symptoms of onychogryphosis or have concerns about your toenails, consulting a <\/span><a href=\"https:\/\/primarycaredoctormiami.com\/old\/our-providers\/\"><b>primary doctor in Miami<\/b><\/a><span style=\"font-weight: 400;\"> is advisable. They can:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Perform a physical examination.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Assess your symptoms.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recommend appropriate treatment options.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Refer you to a podiatrist or dermatologist if necessary.<\/span><\/li>\n<\/ul>\n<p><b>Key Takeaways:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Onychogryphosis is a nail disorder characterized by thickened, curved, and discolored nails.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Various factors can contribute to the condition, including trauma, aging, and fungal infections.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Treatment options range from regular nail trimming to surgical intervention.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Consult a primary doctor in Miami for evaluation and treatment.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Remember, this article is for informational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">FAQs: Onychogryphosis<\/span><\/h2>\n<ol>\n<li aria-level=\"1\"><b>Is onychogryphosis contagious?<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Onychogryphosis itself is not contagious. However, if it&#8217;s caused by a fungal infection, that infection can be contagious and may spread to other nails or people.<\/span><\/li>\n<li aria-level=\"1\"><b>Can I treat onychogryphosis at home?<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">While you can trim your nails at home, onychogryphosis often requires professional nail care from a podiatrist. They can safely and effectively trim thickened nails and address any underlying causes.<\/span><\/li>\n<li aria-level=\"1\"><b>What are the risks of leaving onychogryphosis untreated?<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">Untreated onychogryphosis can lead to pain, infection, ingrown toenails, and difficulty walking. In severe cases, it can also impact your quality of life.<\/span><\/li>\n<li aria-level=\"1\"><b>Are there any ways to prevent onychogryphosis?<\/b><b><br \/>\n<\/b><span style=\"font-weight: 400;\">While some causes, like aging or genetics, are unavoidable, you can reduce your risk by:<\/span><\/p>\n<ul>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Practicing proper nail care<\/span><\/li>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Wearing comfortable and well-fitting shoes<\/span><\/li>\n<li aria-level=\"1\"><span style=\"font-weight: 400;\">Protecting your nails from trauma<\/span><\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"1\">\u00a0<b>How can a primary care doctor help with onychogryphosis? <\/b>A primary care doctor in Miami can assess your symptoms, rule out any underlying medical conditions, and refer you to a podiatrist or dermatologist for specialized nail care. They can also help manage any related health concerns, such as poor circulation.<\/li>\n<\/ol>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 awb-sticky awb-sticky-small awb-sticky-medium awb-sticky-large fusion_builder_column_1_3 1_3 fusion-flex-column\" 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style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:50px;width:100%;\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:50px;width:100%;\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:50px;width:100%;\"><\/div><div class=\"fusion-text fusion-text-3\"><h4 style=\"text-align: left;\">Contact Us<\/h4>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:0px;margin-bottom:30px;width:100%;max-width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:var(--awb-color4);border-color:var(--awb-color4);border-top-width:2px;\"><\/div><\/div><div class=\"fusion-text fusion-text-4\"><p><strong>Hiriart &amp; Lopez MD, LLC<\/strong><br \/>\n9950 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