Provider Demographics
NPI:1669464285
Name:HERMAN, PETER SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SIMON
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2100 N MESA
Mailing Address - Street 2:PETER S HERMAN MD PA
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3312
Mailing Address - Country:US
Mailing Address - Phone:915-544-3800
Mailing Address - Fax:915-544-3008
Practice Address - Street 1:2100 N MESA
Practice Address - Street 2:PETER S HERMAN MD PA
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3312
Practice Address - Country:US
Practice Address - Phone:915-544-3800
Practice Address - Fax:915-544-3008
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207N10002X207ND0900X
TXE3304207N00000X, 207NI0002X, 207NS0135X, 207ND0900X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P2920OtherBCBS
TX8C7887Medicare PIN
C16840Medicare UPIN
8C7887Medicare PIN