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General NPI Number Information
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NPI Number | 1710119953
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Entity Type | Individual
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Provider Name | DARREN T HERZOG MD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 107 E OAK AVE STE 101
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1818
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Country | US
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Telephone | 928-779-7880
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Fax | 928-779-7895
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Provider Business Mailing Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-213-6235
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MED-PHYS-LIC-50222
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 50222
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301092372
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | MED-PHYS-LIC-50222
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License Number State | MT
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 75684
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License Number State | AZ
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