MEDICARE: DR. HERNANDO JESUS TABOADA 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	174400000X	Specialist	ME94629	FL

General Provider Information

NPI Number	:	1619988631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERNANDO JESUS TABOADA M.D.

Provider Business Mailing Address
First Line	:	1153 YARDLEY DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7634
Country	:	US
Telephone Number	:	813-994-0713
Fax Number	:	813-994-0713

Provider Business Practice Location Address
First Line	:	6117 TROUBLE CREEK RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-5240
Country	:	US
Telephone Number	:	727-845-5707
Fax Number	:	727-845-7254

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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