Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC 002238 L | PA |
Y | 222Z00000X | Podiatrist | SC 002238 L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC02238L | PA |
N | 213ES0131X | Foot Surgery | SC02238L | PA |
NPI | 1053400630 |
---|---|
Provider Name | Dr. Robert W. Herpen |
First Address | Philadelphia, PA 19107-2496 |
Second Address | Philadelphia, PA 19107-2496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 07/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000155834 | HIGHMARK BLUE SHIELD (01) | PA |
0008776180001 | (05) | PA |
0060717000 | INDEPENDENCE BLUE CROSS (01) | PA |
T29734 | (02) |