Provider Demographics
NPI:1508862756
Name:HERRMANN, DEBORAH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2305 S HIGHWAY 65 BLDG A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-7800
Mailing Address - Fax:660-831-3306
Practice Address - Street 1:2305 S HIGHWAY 65 BLDG A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-831-3306
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35894207Q00000X
MO36988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36988OtherLICENSE
MO203230651Medicaid
MO18134090OtherBCBS PROV #
IA38157OtherBLUE SHIELD OF IOWA
IAP00192136OtherRAILROAD MEDICARE
IA0454215Medicaid
IAI14621Medicare ID - Type Unspecified
MO18134090OtherBCBS PROV #
MO36988OtherLICENSE
IA38157OtherBLUE SHIELD OF IOWA