Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS16313 | FL |
Y | 207Q00000X | Family Doctor | OS16313 | FL |
NPI | 1124488465 |
---|---|
Provider Name | Nathan Joel Hershberger |
First Address | Orlando, FL 32822-8204 |
Second Address | Orlando, FL 32822-8204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2016 |
Last Update Date | 09/11/2021 |