Basic Information
| Provider Information | |||||||||
| NPI: | 1316940067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERDE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ROY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13627 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857323627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207507160 | ||||||||
| FaxNumber: | 5208861929 | ||||||||
| Practice Location | |||||||||
| Address1: | 6506 E CARONDELET DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857102117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208856717 | ||||||||
| FaxNumber: | 5207229702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 09/09/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/29/2006 | ||||||||
| NPIReactivationDate: | 06/09/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 15572 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.