Provider Demographics
NPI:1104133727
Name:HERMES, ADAM TANNER (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:TANNER
Last Name:HERMES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:TANNER
Other - Middle Name:
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 E 1ST ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-5513
Mailing Address - Fax:218-722-6515
Practice Address - Street 1:1000 E 1ST ST STE 400
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5513
Practice Address - Fax:218-722-6515
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12416363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical