Provider Demographics
NPI:1952433955
Name:HERMANN, BRUCE F (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:F
Last Name:HERMANN
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 1:2900 N I-35
Mailing Address - Street 2:MOB 1, SUITE 409
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5141
Mailing Address - Country:US
Mailing Address - Phone:940-387-4900
Mailing Address - Fax:940-387-4966
Practice Address - Street 1:2900 N I-35
Practice Address - Street 2:MOB 1, SUITE 409
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5141
Practice Address - Country:US
Practice Address - Phone:940-387-4900
Practice Address - Fax:940-387-4966
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5726208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CJ939OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX2138794-01Medicaid
TX2138794-01Medicaid