Provider Demographics
NPI:1831179290
Name:HERMAN, MICHAEL E (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-265-6478
Mailing Address - Fax:904-265-6409
Practice Address - Street 1:1747 BAPTIST CLAY DR STE 300
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8503
Practice Address - Country:US
Practice Address - Phone:904-214-8100
Practice Address - Fax:904-214-8109
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8819207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003213400Medicaid
FL003213400Medicaid