Provider Demographics
NPI:1245498716
Name:HER, SOU (DO)
Entity type:Individual
Prefix:
First Name:SOU
Middle Name:
Last Name:HER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST
Mailing Address - Street 2:STE 10
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3758
Mailing Address - Country:US
Mailing Address - Phone:209-242-2448
Mailing Address - Fax:209-888-0820
Practice Address - Street 1:2800 N CALIFORNIA ST
Practice Address - Street 2:STE 10
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3758
Practice Address - Country:US
Practice Address - Phone:209-242-2448
Practice Address - Fax:209-888-0820
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2022-06-27
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Provider Licenses
StateLicense IDTaxonomies
CA20A11874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine