Provider Demographics
NPI:1457359929
Name:HERMAN, RODNEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:J
Last Name:HERMAN
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 1:3345 BURNS RD 302
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4321
Mailing Address - Country:US
Mailing Address - Phone:561-622-7661
Mailing Address - Fax:561-622-4651
Practice Address - Street 1:3345 BURNS RD 302
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4321
Practice Address - Country:US
Practice Address - Phone:561-622-7661
Practice Address - Fax:561-622-4651
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039319208D00000X
FL39313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
57139Medicare UPIN
61205Medicare ID - Type Unspecified