Provider Demographics
NPI:1952752578
Name:HERZOG, FRANCIS ELIOT
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:ELIOT
Last Name:HERZOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 WESTOVER LN
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7172
Mailing Address - Country:US
Mailing Address - Phone:715-577-4143
Mailing Address - Fax:
Practice Address - Street 1:3351 WESTOVER LN
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7172
Practice Address - Country:US
Practice Address - Phone:715-577-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN811214390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program