Provider Demographics
NPI:1295795177
Name:HERZOG, ERIC FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:FRANCIS
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 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:775-428-2633
Mailing Address - Fax:775-428-2630
Practice Address - Street 1:637 MERCED ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1070
Practice Address - Country:US
Practice Address - Phone:209-722-4842
Practice Address - Fax:866-234-5550
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7071207Q00000X
CAG066400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100204363Medicaid
NV100204363Medicaid
11WCHFM06Medicare ID - Type Unspecified
E25277Medicare UPIN