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General NPI Number Information
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NPI Number | 1023080629
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Entity Type | Organization
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Legal Business Name | HERNANDO MEDICAL INC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 12900 CORTEZ BLVD STE 202
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City | BROOKSVILLE
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State | FL
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Zip | 34613
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Country | US
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Telephone | 352-597-8844
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Fax | 352-597-8831
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Provider Business Mailing Address
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Address Line | 12900 CORTEZ BLVD STE 202
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City | BROOKSVILLE
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State | FL
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Zip | 34613
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Country | US
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Telephone | 352-597-8844
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Fax | 352-597-8831
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MOHAMMAD A JOUD
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Credential | M.D.
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Telephone | 352-597-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME78544
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License Number State | FL
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