Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME43087 | FL |
N | 207XS0106X | Orthopaedic Hand Surgeon | ME43087 | FL |
NPI | 1164425393 |
---|---|
Provider Name | Dr. John David Hermansdorfer |
First Address | Melbourne, FL 32901-3235 |
Second Address | Melbourne, FL 32901-3235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 16/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D94504 | (02) | FL |