Healthcare Provider Details

I. General information

NPI: 1134105075
Provider Name (Legal Business Name): WILLIAM E HERBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST SUITE 400
PORTLAND ME
04102-3100
US

IV. Provider business mailing address

887 CONGRESS ST SUITE 400
PORTLAND ME
04102-3100
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-6368
  • Fax: 207-774-9388
Mailing address:
  • Phone: 207-774-6368
  • Fax: 207-774-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number010628
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number010628
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: