Provider Demographics
NPI:1891720629
Name:CHANG, HERNAN ROBERT (MD,)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:ROBERT
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17577
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7577
Mailing Address - Country:US
Mailing Address - Phone:904-399-1623
Mailing Address - Fax:904-399-1624
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 615
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-399-1623
Practice Address - Fax:904-399-1624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88878207RI0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276058400Medicaid
FL37600YMedicare UPIN
FL276058400Medicaid