Provider Demographics
NPI:1952536294
Name:HERRO, FREDERICK ELLISON (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ELLISON
Last Name:HERRO
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 1:5133 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1438
Mailing Address - Country:US
Mailing Address - Phone:602-264-1818
Mailing Address - Fax:602-264-2172
Practice Address - Street 1:5133 N CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1438
Practice Address - Country:US
Practice Address - Phone:602-264-1818
Practice Address - Fax:602-264-2172
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104129208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist