Provider Demographics
NPI:1023080629
Name:HERNANDO MEDICAL INC
Entity type:Organization
Organization Name:HERNANDO MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-8844
Mailing Address - Street 1:12900 CORTEZ BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613
Mailing Address - Country:US
Mailing Address - Phone:352-597-8844
Mailing Address - Fax:352-597-8831
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:STE 202
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-8844
Practice Address - Fax:352-597-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258942700Medicaid
H04910Medicare UPIN
FL258942700Medicaid