Provider Demographics
NPI:1811957129
Name:HERMAN, FREDERICK N (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:N
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 1:350 NW 84TH AVE
Mailing Address - Street 2:STE 311
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1817
Mailing Address - Country:US
Mailing Address - Phone:954-476-9899
Mailing Address - Fax:954-476-9180
Practice Address - Street 1:350 NW 84TH AVE
Practice Address - Street 2:#311
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-476-9899
Practice Address - Fax:954-476-9180
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33579208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055811700Medicaid
FL94153OtherBCBS OF FL
FL94153WMedicare PIN
D64685Medicare UPIN
FL94153VMedicare PIN
FL94153OtherBCBS OF FL