Provider Demographics
NPI:1861692154
Name:WILLIAM J HERRMANN MD PC
Entity type:Organization
Organization Name:WILLIAM J HERRMANN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-425-2474
Mailing Address - Street 1:PO BOX 3955
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2610
Mailing Address - Country:US
Mailing Address - Phone:928-639-2090
Mailing Address - Fax:928-639-0167
Practice Address - Street 1:5882 S HOSPITAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501
Practice Address - Country:US
Practice Address - Phone:928-425-2474
Practice Address - Fax:928-425-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288458OtherAHCCCS
AZ0001OtherEMC ID
AZ03D104165OtherCLIA LAB
AZ0001OtherEMC ID
Z101990Medicare PIN