MEDICARE: DR. JOSEPH HERNANDEZ 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	208D00000X	General Practice Physician	ME44356	FL
2	207Q00000X	Family Medicine Physician	ME44356	FL
3	207P00000X	Emergency Medicine Physician	ME44356	FL

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
2	94525	OTHER	FL	BCBS
3	ME44356	OTHER	FL	FL LICENSE

General Provider Information

NPI Number	:	1821168378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HERNANDEZ MD

Provider Business Mailing Address
First Line	:	289 SW MACON ST
Second Line	:
City	:	MADISON
State	:	FL
Zip	:	32340
Country	:	US
Telephone Number	:	954-261-9747
Fax Number	:	850-973-4726

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	12/18/2009

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