Healthcare Provider Details

I. General information

NPI: 1053400630
Provider Name (Legal Business Name): ROBERT W. HERPEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH AT RACE ST TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
PHILADELPHIA PA
19107-2496
US

IV. Provider business mailing address

8TH AT RACE ST TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
PHILADELPHIA PA
19107-2496
US

V. Phone/Fax

Practice location:
  • Phone: 215-625-5215
  • Fax: 215-625-9837
Mailing address:
  • Phone: 215-625-5215
  • Fax: 215-625-9837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC02238L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC02238L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC 002238 L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: