Provider Demographics
NPI:1538243167
Name:HERNANDEZ, JORGE L (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:HERNANDEZ
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 1:10101 W COLONIAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4213
Mailing Address - Country:US
Mailing Address - Phone:407-895-9060
Mailing Address - Fax:407-895-9010
Practice Address - Street 1:10101 W COLONIAL DR STE 102
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4213
Practice Address - Country:US
Practice Address - Phone:407-895-9060
Practice Address - Fax:407-895-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066300207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375560600Medicaid
FLME0066300OtherMEDICAL LICENSE NUMBER
FL375560600Medicaid
FL25550XMedicare PIN