Healthcare Provider Details

I. General information

NPI: 1962654806
Provider Name (Legal Business Name): BJORN S HERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 PGA BLVD STE 450
PALM BEACH GARDENS FL
33410-2841
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 561-219-4400
  • Fax: 561-219-4401
Mailing address:
  • Phone: 740-589-3100
  • Fax: 740-589-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME120761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: