Provider Demographics
NPI:1841373743
Name:HERR, STANLEY SAMUEL (DO)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SAMUEL
Last Name:HERR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:41120 WASHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9596
Mailing Address - Country:US
Mailing Address - Phone:760-772-2823
Mailing Address - Fax:760-772-2819
Practice Address - Street 1:41120 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9596
Practice Address - Country:US
Practice Address - Phone:760-772-2823
Practice Address - Fax:760-772-2819
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC59289Medicare UPIN