MEDICARE: DR. JUAN HERNANDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME101136	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00667487	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0807910	OTHER	FL	CIGNA
3	52785	OTHER	FM	BCBS FL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427210970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	708 DEL PRADO BLVD
Second Line	:	S-9
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5616
Country	:	US
Telephone Number	:	239-574-2644
Fax Number	:	239-574-1451

Provider Business Practice Location Address
First Line	:	708 DEL PRADO BLVD
Second Line	:	S-9
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5616
Country	:	US
Telephone Number	:	239-574-2644
Fax Number	:	239-574-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/03/2009

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Directions to “ DR. JUAN HERNANDEZ M.D.” Practice Location

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