Healthcare Provider Details

I. General information

NPI: 1811149610
Provider Name (Legal Business Name): FREDERICK FLINT HERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 SEVEN HILLS DRIVE SUITE 260
HENDERSON NV
89052-4373
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-4480
  • Fax: 702-990-4808
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberN4469
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberN4469
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberGS50788
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number46354
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number13863
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: