MEDICARE: DR. DEBORAH ANN HERRMANN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35894	IA
2	207Q00000X	Family Medicine Physician	36988	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00192136	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36988	OTHER	MO	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	18134090	OTHER	MO	BCBS PROV #
4	38157	OTHER	IA	BLUE SHIELD OF IOWA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508862756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH ANN HERRMANN M.D.

Provider Business Mailing Address
First Line	:	2305 S HIGHWAY 65 BLDG A
Second Line	:
City	:	MARSHALL
State	:	MO
Zip	:	65340-3702
Country	:	US
Telephone Number	:	660-886-7800
Fax Number	:	660-831-3306

Provider Business Practice Location Address
First Line	:	2305 S HIGHWAY 65 BLDG A
Second Line	:
City	:	MARSHALL
State	:	MO
Zip	:	65340-3702
Country	:	US
Telephone Number	:	660-886-7800
Fax Number	:	660-831-3306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/05/2023

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Directions to “ DR. DEBORAH ANN HERRMANN M.D.” Practice Location

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