Provider Demographics
NPI:1144436338
Name:HEROLD, DANIEL WILFRED (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WILFRED
Last Name:HEROLD
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 1:225 4TH AVE N
Mailing Address - Street 2:FARGO MEPS
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4841
Mailing Address - Country:US
Mailing Address - Phone:701-234-0859
Mailing Address - Fax:701-232-0765
Practice Address - Street 1:225 4TH AVE N
Practice Address - Street 2:FARGO MEPS
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4841
Practice Address - Country:US
Practice Address - Phone:701-234-0859
Practice Address - Fax:701-232-0765
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine