Provider Demographics
NPI:1508831504
Name:HERSCH, PAUL J (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:HERSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4959 N STATE RD 7
Mailing Address - Street 2:STE C
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-484-8850
Mailing Address - Fax:954-484-8851
Practice Address - Street 1:4959 N STATE RD 7
Practice Address - Street 2:STE C
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-484-8850
Practice Address - Fax:954-484-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL245925OtherAVMED
FL5883296OtherAETNA
FL78066OtherBLUE CROSS BLUE SHIELD
FL110716OtherHUMANA
FL061347900Medicaid
FL061347900Medicaid
D58350Medicare UPIN