Healthcare Provider Details

I. General information

NPI: 1972828499
Provider Name (Legal Business Name): CANAAN S. HERRYGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5259 VILLAGE MARKET
WESLEY CHAPEL FL
33544-8401
US

IV. Provider business mailing address

4033 TAMPA RD STE 101
OLDSMAR FL
34677-3224
US

V. Phone/Fax

Practice location:
  • Phone: 813-973-0333
  • Fax: 813-973-0333
Mailing address:
  • Phone: 813-854-2003
  • Fax: 813-855-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 116171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: