Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5000425-015 | WI |
N | 1223P0300X | Periodontist | 5000425015 | WI |
NPI | 1003052895 |
---|---|
Provider Name | Dr. James P. Herman |
First Address | Hales Corners, WI 53130-1674 |
Second Address | Hales Corners, WI 53130-1674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2008 |
Last Update Date | 28/12/2008 |