Provider Demographics
NPI:1235166885
Name:HERROLD, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:HERROLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2499 N CORSEY WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-440-6345
Mailing Address - Fax:208-344-8355
Practice Address - Street 1:3875 E OVERLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9005
Practice Address - Country:US
Practice Address - Phone:208-343-6200
Practice Address - Fax:208-344-8355
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM73212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG50630Medicare UPIN