Provider Demographics
NPI:1437190824
Name:HERZOG, JAMES (CSA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:HERZOG
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 W GLENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-0733
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:480-461-0945
Practice Address - Street 1:1104 W GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85045-0733
Practice Address - Country:US
Practice Address - Phone:480-706-9430
Practice Address - Fax:480-461-0945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical