Healthcare Provider Details

I. General information

NPI: 1508862756
Provider Name (Legal Business Name): DEBORAH ANN HERRMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S HIGHWAY 65 BLDG A
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

2305 S HIGHWAY 65 BLDG A
MARSHALL MO
65340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7800
  • Fax: 660-831-3306
Mailing address:
  • Phone: 660-886-7800
  • Fax: 660-831-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35894
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36988
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: