MEDICARE: DAVID ROBERT HERRMANN P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	3682	AZ

General Provider Information

NPI Number	:	1225225642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERT HERRMANN P.A.

Provider Business Mailing Address
First Line	:	4140 E RAYMOND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-1933
Country	:	US
Telephone Number	:	602-437-7034
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 E RAYMOND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-1933
Country	:	US
Telephone Number	:	602-437-7034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2007
Last Update Date	:	01/21/2014

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