Provider Demographics
NPI:1386632859
Name:HERRMANN, WILLIAM J (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9250 N 3RD ST STE 4010
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2432
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2624
Practice Address - Country:US
Practice Address - Phone:623-512-4390
Practice Address - Fax:623-512-4391
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ18619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ288458Medicaid
B41422Medicare UPIN
AZZ154298Medicare PIN