Healthcare Provider Details

I. General information

NPI: 1801071758
Provider Name (Legal Business Name): J. MICHAEL HERR DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

39 WEBSTER HILL BLVD
WEST HARTFORD CT
06107-3458
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-2515
  • Fax:
Mailing address:
  • Phone: 860-561-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039908
License Number StateCT

VIII. Authorized Official

Name: JAMES MICHAEL HERR
Title or Position: DOCTOR
Credential: DO
Phone: 860-561-1556