MEDICARE: DR. JORGE L. HERNANDEZ 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	ME72848	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00121898	OTHER	FL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200472730	OTHER	FL	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	41619	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932192325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L. HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	250 2ND STREET EAST
Second Line	:	SUITE 3B
City	:	BRADENTON
State	:	FL
Zip	:	34208-1029
Country	:	US
Telephone Number	:	941-746-4151
Fax Number	:	941-746-4345

Provider Business Practice Location Address
First Line	:	250 2ND STREET EAST
Second Line	:	SUITE 3B
City	:	BRADENTON
State	:	FL
Zip	:	34208-1029
Country	:	US
Telephone Number	:	941-746-4151
Fax Number	:	941-746-4345

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/26/2015

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Directions to “ DR. JORGE L. HERNANDEZ M.D.” Practice Location

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