Provider Demographics
NPI:1427115625
Name:HERMENAU, SHAWN FREDRICK (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:FREDRICK
Last Name:HERMENAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2851 S AVENUE B
Mailing Address - Street 2:SUITE 2401
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7726
Mailing Address - Country:US
Mailing Address - Phone:928-247-9714
Mailing Address - Fax:928-247-9718
Practice Address - Street 1:2851 S AVENUE B
Practice Address - Street 2:SUITE 2401
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-247-9714
Practice Address - Fax:928-247-9718
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI12016207X00000X
AZ36539207X00000X
NHLT-2571207X00000X
LA200708207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ542030Medicaid
AZ542030Medicaid