Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | E3304 | TX |
N | 207ND0900X | Dermatopathologist | 207N10002X | TX |
N | 207ND0900X | Dermatopathologist | E3304 | TX |
N | 207NP0225X | Pediatric Dermatologist | E3304 | TX |
N | 207NS0135X | Procedural Dermatology | E3304 | TX |
NPI | 1669464285 |
---|---|
Provider Name | Dr. Peter Simon Herman |
First Address | El Paso, TX 79902-3312 |
Second Address | El Paso, TX 79902-3312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 28/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8P2920 | BCBS (01) | TX |
C16840 | (02) |