Healthcare Provider Details

I. General information

NPI: 1982081972
Provider Name (Legal Business Name): JOSUE HERNANDEZ PASOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 07/21/2022
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

340 NW COMMERCE DR
LAKE CITY FL
32055-4709
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME143169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: