Healthcare Provider Details

I. General information

NPI: 1366448177
Provider Name (Legal Business Name): DANIEL JOSEPH HEROLD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4451
US

IV. Provider business mailing address

PO BOX 2176
HASTINGS NE
68902-2176
US

V. Phone/Fax

Practice location:
  • Phone: 402-461-5191
  • Fax: 402-461-5088
Mailing address:
  • Phone: 402-463-0404
  • Fax: 402-462-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20397
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: