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General NPI Number Information
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NPI Number | 1811126048
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Entity Type | Individual
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Provider Name | MITCHELL RAY HERREMA D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1011 JEFFORDS ST BLDG C
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City | CLEARWATER
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State | FL
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Zip | 33756
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Country | US
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Telephone | 727-446-5993
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Fax | 727-446-4477
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Provider Business Mailing Address
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Address Line | 5901 E FOWLER AVE STE 100
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2305
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Country | US
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Telephone | 813-978-9700
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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 | OS12585
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | OS12585
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License Number State | FL
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