Healthcare Provider Details

I. General information

NPI: 1295795177
Provider Name (Legal Business Name): ERIC FRANCIS HERZOG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 MERCED ST
NEWMAN CA
95360-1070
US

IV. Provider business mailing address

2345 E PRATER WAY STE 207
SPARKS NV
89434-9634
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax: 866-234-5550
Mailing address:
  • Phone: 775-428-2633
  • Fax: 775-428-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7071
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG066400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: