Provider Demographics
NPI:1659384618
Name:HERMAN, ROBERTA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:MARIE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 PRESERVATION CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7378
Mailing Address - Country:US
Mailing Address - Phone:512-327-9173
Mailing Address - Fax:
Practice Address - Street 1:11651 JOLLYVILLE RD
Practice Address - Street 2:#150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3931
Practice Address - Country:US
Practice Address - Phone:512-258-6144
Practice Address - Fax:512-258-6234
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16837Medicare UPIN