MEDICARE: JOSEPH M HERNANDEZ MD PA

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	261QP3300X	Pain Clinic/Center

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

General Provider Information

NPI Number	:	1003148016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH M HERNANDEZ MD PA

Provider Business Mailing Address
First Line	:	826 SW MAIN BLVD STE 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5742
Country	:	US
Telephone Number	:	386-754-0600
Fax Number	:	386-755-9737

Provider Business Practice Location Address
First Line	:	826 SW MAIN BLVD STE 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-5742
Country	:	US
Telephone Number	:	386-754-0600
Fax Number	:	386-755-9737

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	DR. JOSEPH M HERNANDEZ
Credential	:	M,D.
Telephone Number	:	386-754-0600

Provider Enumeration Date	:	02/02/2010
Last Update Date	:	02/02/2010

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