Provider Demographics
NPI:1861442899
Name:HERMANN, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:HERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 THILLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5413
Mailing Address - Country:US
Mailing Address - Phone:805-639-9332
Mailing Address - Fax:805-639-9367
Practice Address - Street 1:5850 THILLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5413
Practice Address - Country:US
Practice Address - Phone:805-639-9332
Practice Address - Fax:805-639-9367
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG080153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40195Medicare UPIN