Provider Demographics
NPI:1629480017
Name:HERTEL, ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HERTEL
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 1:201 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-2343
Mailing Address - Country:US
Mailing Address - Phone:940-889-5583
Mailing Address - Fax:940-889-8835
Practice Address - Street 1:201 STADIUM DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2343
Practice Address - Country:US
Practice Address - Phone:903-877-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050107207Q00000X
TXQ6846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine