Healthcare Provider Details

I. General information

NPI: 1114006053
Provider Name (Legal Business Name): DIANA M HERMAN M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 N 40TH ST SUITE 105
PHOENIX AZ
85032-4636
US

IV. Provider business mailing address

15255 N 40TH ST SUITE 105
PHOENIX AZ
85032-4636
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-2690
  • Fax: 602-404-1904
Mailing address:
  • Phone: 602-867-2690
  • Fax: 602-404-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14788
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: