Provider Demographics
NPI:1124091772
Name:HERZ, JEFFREY HAROLD (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HAROLD
Last Name:HERZ
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 1:39000 BOB HOPE DR
Mailing Address - Street 2:KIEWIT BLDG. STE. 401
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-346-1882
Mailing Address - Fax:760-346-1742
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:KIEWIT BLDG. STE. 401
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-346-1882
Practice Address - Fax:760-346-1742
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30050208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G300501OtherMEDICARE PROVIDER NUMBER
CA00G300501Medicaid
CA00G300501OtherMEDICARE PROVIDER NUMBER
CA2008118Medicare PIN