Provider Demographics
NPI:1336232784
Name:HERCULE, HANTZ C (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:HANTZ
Middle Name:C
Last Name:HERCULE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:HANTZ
Other - Middle Name:C
Other - Last Name:HERCULE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 1618
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32353-1618
Mailing Address - Country:US
Mailing Address - Phone:850-662-4070
Mailing Address - Fax:850-662-4047
Practice Address - Street 1:809 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2623
Practice Address - Country:US
Practice Address - Phone:850-662-4070
Practice Address - Fax:850-662-4047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16504208D00000X
FLACN242208D00000X
GA63663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine