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Individual

JERRY LEO HEDRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 VONDERBURG DRIVE, STE 115W, BRANDON, FL 33511-5969
(813) 685-0306
(813) 651-1026
Mailing address
4651 VAN DYKE RD, LUTZ, FL 33558-4880
(813) 321-1786
(813) 321-1787

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME38730
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
070000215
RAILROAD MEDICARE
FL
05
101936200
FL
01
30425
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/12/2006
Last updated
11/06/2019
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