Healthcare Provider Details

I. General information

NPI: 1689657900
Provider Name (Legal Business Name): G. JOSEPH HERR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: G JOSEPH HERR MD

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN SUITE 225
DANVILLE IN
46122-1989
US

IV. Provider business mailing address

1100 SOUTHFIELD DR SUITE 1370
PLAINFIELD IN
46168-4498
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4730
  • Fax: 317-718-4733
Mailing address:
  • Phone: 317-837-5571
  • Fax: 317-837-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberIN01030242
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: