Provider Demographics
NPI:1225225642
Name:HERRMANN, DAVID ROBERT (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:HERRMANN
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 1:4140 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-1933
Mailing Address - Country:US
Mailing Address - Phone:602-437-7034
Mailing Address - Fax:
Practice Address - Street 1:4140 E RAYMOND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-1933
Practice Address - Country:US
Practice Address - Phone:602-437-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant