Healthcare Provider Details

I. General information

NPI: 1124026497
Provider Name (Legal Business Name): KIMBERLY ANN HEROUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 MILITARY TRL #101
JUPITER FL
33458-4839
US

IV. Provider business mailing address

1395 S STATE ROAD 7 #450
WELLINGTON FL
33414-9325
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-3722
  • Fax: 561-799-3692
Mailing address:
  • Phone: 561-798-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME96455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: