Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 44716 | CO |
N | 208200000X | Surgeon | 44716 | CO |
N | 208600000X | Surgeon | 44716 | CO |
N | 2082S0105X | Plastic Hand Surgeon | 44716 | CO |
N | 208200000X | Surgeon | 44716 | CO |
N | 208600000X | Surgeon | 44716 | CO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 44716 | CO |
NPI | 1629085196 |
---|---|
Provider Name | Dr. Glenn Eric Herrmann |
First Address | Lafayette, CO 80026-0767 |
Second Address | Lafayette, CO 80026-7014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 29/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15035859 | (05) | CO |