Provider Demographics
NPI:1760493563
Name:HERMAN, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HERMAN
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 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 810
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8987
Practice Address - Country:US
Practice Address - Phone:352-674-8700
Practice Address - Fax:352-674-8714
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3H88207RC0000X
KS04-25343207RC0000X
FLME117376207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100407060AMedicaid
KS101472OtherBCBS KS
MO13826036OtherBCBS KC
FLME117376OtherSTATE MEDICAL LICENSE
KS100407060BMedicaid
MO202514311Medicaid
MO0387134AMedicare PIN
KS0387134BMedicare PIN
C52292Medicare UPIN
KS100407060AMedicaid
KS060067356Medicare PIN
MO0387134EMedicare PIN
MO202514311Medicaid
KS100407060BMedicaid