Healthcare Provider Details

I. General information

NPI: 1295999720
Provider Name (Legal Business Name): THOMAS RICHARD HERMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 W 23RD ST
PANAMA CITY FL
32405-4507
US

IV. Provider business mailing address

3345 STATE AVE
PANAMA CITY FL
32405-3346
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-7903
  • Fax: 850-747-7156
Mailing address:
  • Phone: 716-440-7706
  • Fax: 850-747-7156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: