Healthcare Provider Details

I. General information

NPI: 1811957129
Provider Name (Legal Business Name): FREDERICK N. HERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 84TH AVE #311
PLANTATION FL
33324-1817
US

IV. Provider business mailing address

350 NW 84TH AVE STE 311
PLANTATION FL
33324-1817
US

V. Phone/Fax

Practice location:
  • Phone: 954-476-9899
  • Fax: 954-476-9180
Mailing address:
  • Phone: 954-476-9899
  • Fax: 954-476-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME33579
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME33579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: