Healthcare Provider Details

I. General information

NPI: 1447612163
Provider Name (Legal Business Name): ROBERT J HERBST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 6TH AVE
DAYTON KY
41074-1116
US

IV. Provider business mailing address

600 MEIJER DR STE 104
FLORENCE KY
41042-4878
US

V. Phone/Fax

Practice location:
  • Phone: 859-757-8262
  • Fax: 859-282-0976
Mailing address:
  • Phone: 859-757-8262
  • Fax: 859-282-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00353
License Number StateKY

VIII. Authorized Official

Name: DR. ROBERT J HERBST
Title or Position: OWNER
Credential: DPM
Phone: 859-757-8262