Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G7229 | TX |
NPI | 1053494484 |
---|---|
Provider Name | Dr. Darrell Hermann |
First Address | Plano, TX 75093-8466 |
Second Address | Plano, TX 75093-8466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1325581-01 | (05) | TX |
C16842 | (02) | TX |