Provider Demographics
NPI:1518950187
Name:HERRMAN, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HERRMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:200 3RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-792-0340
Practice Address - Fax:941-567-1124
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062922208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1193128OtherWELLCARE
FL340007838OtherMEDICARE RAILROAD
FL4386620OtherAETNA
GAP01781536OtherCLEAR HEALTH ALLIANCE
FLP102262OtherFREEDOM HEALTH
FL012602900Medicaid
FL08971OtherUNIVERSAL
FL17999OtherBCBS FL
FL206590OtherAVMED
FLP01040801OtherRAILROAD MCR
FLP939407OtherOPTIMUM
FLP102262OtherFREEDOM HEALTH
FL17999WMedicare PIN
FL08971OtherUNIVERSAL