Provider Demographics
NPI:1326026279
Name:HEROLD, EDWARD D (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:HEROLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1825 LOGAN AVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1916
Mailing Address - Country:US
Mailing Address - Phone:319-235-3697
Mailing Address - Fax:319-235-3844
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3697
Practice Address - Fax:319-235-3844
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01533207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0065037Medicaid
IA00162OtherWELLMARK BC/BS IOWA
IA0065037Medicaid
IA21774Medicare PIN