MEDICARE: DR. HALE E HEDLEY MD

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	207P00000X	Emergency Medicine Physician	ME94099	FL
2	207Q00000X	Family Medicine Physician	ME94099	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29104	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669406260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HALE E HEDLEY MD

Provider Business Mailing Address
First Line	:	6817 SOUTHPOINT PKWY STE 1704
Second Line	:	#1704
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6298
Country	:	US
Telephone Number	:	904-222-8500
Fax Number	:	800-388-0270

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 1704
Second Line	:	#1704
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6298
Country	:	US
Telephone Number	:	904-222-8500
Fax Number	:	800-388-0270

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/20/2014

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Directions to “ DR. HALE E HEDLEY MD” Practice Location

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