Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 039908 | CT |
N | 207Q00000X | Family Doctor | 039908 | CT |
NPI | 1316995442 |
---|---|
Provider Name | J.michael Herr |
First Address | West Hartford, CT 06107-2402 |
Second Address | West Hartford, CT 06107-2402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 29/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80-0090424 | FEIN (01) | |
D71717 | (02) | CT |