Basic Information
| Provider Information | |||||||||
| NPI: | 1629480017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERTEL | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | SEYMOUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763802343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9408895583 | ||||||||
| FaxNumber: | 9408898835 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 STADIUM DR | ||||||||
| Address2: | |||||||||
| City: | SEYMOUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763802343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038777200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2014 | ||||||||
| LastUpdateDate: | 06/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10050107 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Q6846 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.