Provider Demographics
NPI:1639174196
Name:HERMANSON, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HERMANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:865 LINCOLN RD
Practice Address - Street 2:STE 400
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4159
Practice Address - Country:US
Practice Address - Phone:563-359-7548
Practice Address - Fax:563-359-7540
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA22112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4796890004OtherDMERC
29591OtherWELLMARK BC/BS
19867OtherIOWA HEALTH SOLUTIONS
034785OtherHEALTH ALLIANCE
IA3193615Medicaid
IA0137OtherJOHN DEERE HEALTH PLAN
034785OtherHEALTH ALLIANCE
4796890004OtherDMERC