Individual
DR. JOSEPH HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
826 SW MAIN BLVD STE 102, LAKE CITY, FL 32025-5742
(386) 754-0600
(386) 755-9737
Mailing address
289 SW MACON ST, MADISON, FL 32340
(954) 261-9747
(850) 973-4726
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME44356
FL
207Q00000X
Family Medicine Physician
ME44356
FL
208D00000X
General Practice Physician
ME44356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277541700
—
FL
01
—
94525
BCBS
FL
01
—
ME44356
FL LICENSE
FL
Enumeration date
11/09/2006
Last updated
12/18/2009
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