Provider Demographics
NPI:1316061021
Name:HEROLD, FREDERICK STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:STEPHEN
Last Name:HEROLD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:ADULT PRIMARY CARE CLINIC; MEMORIAL HEALTHCARE SYSTEM
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5663
Mailing Address - Fax:954-276-0301
Practice Address - Street 1:4105 PEMBROKE ROAD
Practice Address - Street 2:ADULT PRIMARY CARE CLINIC; MEMORIAL HEALTHCARE SYSTEM
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8103
Practice Address - Country:US
Practice Address - Phone:954-985-1551
Practice Address - Fax:954-985-1415
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-04-28
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Provider Licenses
StateLicense IDTaxonomies
FLME 17069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51785Medicare UPIN