Basic Information
| Provider Information | |||||||||
| NPI: | 1811149610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMAN | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | FLINT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2285 CORPORATE CIR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890747759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023602763 | ||||||||
| FaxNumber: | 9497832880 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 SEVEN HILLS DRIVE | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890524373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029904480 | ||||||||
| FaxNumber: | 7029904808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2008 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | N4469 | TX | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207KA0200X | N4469 | TX | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207KA0200X | GS50788 | CA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207KA0200X | 46354 | AZ | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207K00000X | 13863 | NV | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 6063718 | 05 | CA | MEDICAID |