Healthcare Provider Details

I. General information

NPI: 1164425393
Provider Name (Legal Business Name): JOHN DAVID HERMANSDORFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S. HARBOR CITY BLVD SUITE 420
MELBOURNE FL
32901
US

IV. Provider business mailing address

2222 S. HARBOR CITY BLVD SUITE 420
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-768-9914
  • Fax: 321-953-1893
Mailing address:
  • Phone: 321-768-9914
  • Fax: 321-953-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME43087
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME43087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: