Provider Demographics
NPI:1720130495
Name:HERMAN, CRAIG WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
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 1:550 SW 3RD STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:POMPANO
Mailing Address - State:FL
Mailing Address - Zip Code:33060
Mailing Address - Country:US
Mailing Address - Phone:954-941-3333
Mailing Address - Fax:954-941-2054
Practice Address - Street 1:550 SW 3RD STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060
Practice Address - Country:US
Practice Address - Phone:954-941-3333
Practice Address - Fax:954-941-2054
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43959208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043599600Medicaid
FL043599600Medicaid
FL94309YMedicare ID - Type Unspecified