Healthcare Provider Details

I. General information

NPI: 1316995442
Provider Name (Legal Business Name): J.MICHAEL HERR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES M. HERR D.O.

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S MAIN ST STE 212
WEST HARTFORD CT
06107-2402
US

IV. Provider business mailing address

45 S MAIN ST STE 212
WEST HARTFORD CT
06107-2402
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-2515
  • Fax: 860-236-2572
Mailing address:
  • Phone: 860-236-2515
  • Fax: 860-236-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number039908
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039908
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: