Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME104634 | FL |
N | 208600000X | Surgeon | ME104634 | FL |
N | 208800000X | Urologist | D65299 | MD |
Y | 208800000X | Urologist | ME104634 | FL |
NPI | 1063564060 |
---|---|
Provider Name | Dr. David Joseph Hernandez |
First Address | Tampa, FL 33611-2808 |
Second Address | Tampa, FL 33606-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001058400 | (05) | FL |
1464F | BLUE CROSS BLUE SHIELD (01) | FL |