Provider Demographics
NPI:1295828309
Name:HERZOG, JO LYNNE (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:LYNNE
Last Name:HERZOG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 MONTGOMERY HWY STE 114
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2750
Mailing Address - Country:US
Mailing Address - Phone:205-379-0900
Mailing Address - Fax:205-206-6576
Practice Address - Street 1:1360 MONTGOMERY HWY STE 114
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2750
Practice Address - Country:US
Practice Address - Phone:053-790-9002
Practice Address - Fax:205-206-6576
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-12103OtherBC BS OF AL
051512103Medicare PIN
ALC71863Medicare UPIN