MEDICARE: JOSE A. 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	207Q00000X	Family Medicine Physician	ME65951	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

General Provider Information

NPI Number	:	1942220660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A. HERNANDEZ MD

Provider Business Mailing Address
First Line	:	450 S MAIN ST
Second Line	:	SUITE 1
City	:	LABELLE
State	:	FL
Zip	:	33935-4629
Country	:	US
Telephone Number	:	863-675-2356
Fax Number	:	863-675-2407

Provider Business Practice Location Address
First Line	:	450 S MAIN ST
Second Line	:	SUITE 1
City	:	LABELLE
State	:	FL
Zip	:	33935-4629
Country	:	US
Telephone Number	:	863-675-2356
Fax Number	:	863-675-2407

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/04/2014

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