Provider Demographics
NPI:1861599466
Name:HERZOG, RUDOLF ERICH (MD)
Entity type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:ERICH
Last Name:HERZOG
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 1:106 THORN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5629
Mailing Address - Country:US
Mailing Address - Phone:619-985-0851
Mailing Address - Fax:619-686-3440
Practice Address - Street 1:106 THORN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5629
Practice Address - Country:US
Practice Address - Phone:619-615-0842
Practice Address - Fax:619-615-0864
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine