Healthcare Provider Details

I. General information

NPI: 1073508180
Provider Name (Legal Business Name): GERMAN HERRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N E ST SUITE 231
PENSACOLA FL
32501-6339
US

IV. Provider business mailing address

245 W AIRPORT BLVD
PENSACOLA FL
32505-2254
US

V. Phone/Fax

Practice location:
  • Phone: 850-469-7975
  • Fax:
Mailing address:
  • Phone: 850-475-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME68223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: