Provider Demographics
NPI:1962654806
Name:HERMAN, BJORN S (MD)
Entity type:Individual
Prefix:
First Name:BJORN
Middle Name:S
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-589-3100
Mailing Address - Fax:740-589-3123
Practice Address - Street 1:3401 PGA BLVD STE 450
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2841
Practice Address - Country:US
Practice Address - Phone:561-219-4400
Practice Address - Fax:561-219-4401
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2019-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME120761207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000495011OtherOH MEDICAID UNISON
OH310917085299OtherCARESOURCE
OH0068169Medicaid
WV3810023527Medicaid
OH000000495011OtherOH MEDICAID UNISON