Healthcare Provider Details

I. General information

NPI: 1326604851
Provider Name (Legal Business Name): ALLAN TILDEN HERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LEGION DR
LAS VEGAS NM
87701-4804
US

IV. Provider business mailing address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 505-426-3504
  • Fax:
Mailing address:
  • Phone: 407-646-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2022-0905
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: