Basic Information
| Provider Information | |||||||||
| NPI: | 1144725557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOENEMEYER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277385037 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277385037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | ME145327 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 108137200 | 05 | FL | MEDICAID |