Provider Demographics
NPI:1295821288
Name:HERRMANN, WILLIAM FREDERICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11599
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-0599
Mailing Address - Country:US
Mailing Address - Phone:949-855-4634
Mailing Address - Fax:
Practice Address - Street 1:234 E 17TH ST
Practice Address - Street 2:SUITE #104
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3825
Practice Address - Country:US
Practice Address - Phone:949-855-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3248213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480010316OtherRAILROAD MEDICARE
T11598Medicare UPIN
E3248Medicare ID - Type Unspecified