MEDICARE: DR. JOSEPH P HERMOSA 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	207R00000X	Internal Medicine Physician	L4435	TX

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	:	1306885124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH P HERMOSA M.D.

Provider Business Mailing Address
First Line	:	402A W PALM VALLEY BLVD # 350
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4237
Country	:	US
Telephone Number	:	512-630-1969
Fax Number	:	512-240-5026

Provider Business Practice Location Address
First Line	:	402A W PALM VALLEY BLVD # 350
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4237
Country	:	US
Telephone Number	:	512-630-1969
Fax Number	:	512-240-5026

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/05/2020

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