Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 35038198 | OH |
NPI | 1073573218 |
---|---|
Provider Name | Edward B. Herzig |
First Address | Fairfield, OH 45014-2738 |
Second Address | Fairfield, OH 45014-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0377159 | (05) | OH |
A77925 | (02) | OH |
P00824188 | MEDICARE RR (01) | OH |