Provider Demographics
NPI:1386697159
Name:HERMAN, LEE SCOTT (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:SCOTT
Last Name:HERMAN
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 1:900 S 1ST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7527
Mailing Address - Country:US
Mailing Address - Phone:626-566-2750
Mailing Address - Fax:626-566-2756
Practice Address - Street 1:900 S 1ST AVE
Practice Address - Street 2:STE C
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7527
Practice Address - Country:US
Practice Address - Phone:626-566-2750
Practice Address - Fax:626-566-2756
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G389440Medicaid
CAWG38944SMedicare PIN
CAA47643Medicare UPIN