Provider Demographics
NPI:1710119953
Name:HERZOG, DARREN T (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:T
Last Name:HERZOG
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859
Mailing Address - Country:US
Mailing Address - Phone:406-826-4800
Mailing Address - Fax:406-826-4803
Practice Address - Street 1:10 KRUGER RD
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859
Practice Address - Country:US
Practice Address - Phone:406-826-4800
Practice Address - Fax:406-826-4803
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092372207X00000X
MTMED-PHYS-LIC-50222207X00000X, 207XS0114X
MT50222207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630880Medicare PIN