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General NPI Number Information
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NPI Number | 1093734949
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Entity Type | Individual
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Provider Name | JOHN L HERZOG SR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 1421 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3247
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Country | US
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Telephone | 662-335-0183
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Fax | 662-335-7184
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Provider Business Mailing Address
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Address Line | PO BOX 5368
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City | GREENVILLE
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State | MS
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Zip | 38704-5368
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Country | US
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Telephone | 662-394-0107
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Fax | 662-335-7184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 09800
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License Number State | MS
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