Provider Demographics
NPI:1265642425
Name:HERZOG, JOHN PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:HERZOG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:98 CLEARWATER DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1398
Mailing Address - Country:US
Mailing Address - Phone:207-781-9077
Mailing Address - Fax:207-347-8285
Practice Address - Street 1:98 CLEARWATER DR
Practice Address - Street 2:SUITE 4
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1398
Practice Address - Country:US
Practice Address - Phone:207-781-9077
Practice Address - Fax:207-347-8285
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1107207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E13872Medicare UPIN
HE015762Medicare ID - Type Unspecified