Provider Demographics
NPI:1023196284
Name:HERRMAN, STEVEN (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:HERRMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W MINGUS AVE STE 1F
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4006
Mailing Address - Country:US
Mailing Address - Phone:928-634-0123
Mailing Address - Fax:
Practice Address - Street 1:651 W MINGUS AVE STE 1F
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4006
Practice Address - Country:US
Practice Address - Phone:928-634-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ498510OtherAHCCS
AZ498510OtherAHCCS
AZS30542Medicare UPIN
AZ62691Medicare ID - Type Unspecified
AZ63696Medicare ID - Type Unspecified