Provider Demographics
NPI:1194756387
Name:HERMAN, DWIGHT B (CRNA)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:B
Last Name:HERMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5909
Mailing Address - Country:US
Mailing Address - Phone:903-891-7000
Mailing Address - Fax:903-813-1479
Practice Address - Street 1:500 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7354
Practice Address - Country:US
Practice Address - Phone:903-870-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700502367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165451903/165451904Medicaid
TX165451902Medicaid
TXP00220867OtherRAILROAD MEDICARE
TX89509UOtherBCBS
TX84813UOtherBLUE CROSS BLUE SHIELD
TX8L6629/TXB134424Medicare PIN
TX165451902Medicaid