Healthcare Provider Details

I. General information

NPI: 1003869330
Provider Name (Legal Business Name): PAUL D. HERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ERRECART BLVD SUITE 110
ELKO NV
89801-8334
US

IV. Provider business mailing address

1995 ERRECART BLVD SUITE 110
ELKO NV
89801-8334
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-2210
  • Fax: 775-777-1113
Mailing address:
  • Phone: 775-777-2210
  • Fax: 775-777-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9637
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: