Provider Demographics
NPI:1396739272
Name:HERMANN, HEINZ J (MD)
Entity type:Individual
Prefix:
First Name:HEINZ
Middle Name:J
Last Name:HERMANN
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 1:3801 VISTA RD
Mailing Address - Street 2:STE 420
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2159
Mailing Address - Country:US
Mailing Address - Phone:713-941-7202
Mailing Address - Fax:713-941-1703
Practice Address - Street 1:3801 VISTA RD
Practice Address - Street 2:STE 420
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2159
Practice Address - Country:US
Practice Address - Phone:713-941-7202
Practice Address - Fax:713-941-1703
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE2611207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1386953537OtherGROUP NPI
TX100140602Medicaid
TX100140602Medicaid
TX00T352Medicare ID - Type Unspecified