Provider Demographics
NPI:1093974172
Name:HERRMANN, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 MILLS CIVIC PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8345
Mailing Address - Country:US
Mailing Address - Phone:515-224-9666
Mailing Address - Fax:515-224-5913
Practice Address - Street 1:6010 MILLS CIVIC PKWY
Practice Address - Street 2:STE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8345
Practice Address - Country:US
Practice Address - Phone:515-224-9666
Practice Address - Fax:515-224-5913
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8768207Q00000X
KS94-06938208600000X
IA38714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1093974172Medicaid
IA719260250Medicare PIN