Basic Information
| Provider Information | |||||||||
| NPI: | 1508831504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERSCH | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4959 N STATE RD 7 | ||||||||
| Address2: | STE C | ||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544848850 | ||||||||
| FaxNumber: | 9544848851 | ||||||||
| Practice Location | |||||||||
| Address1: | 4959 N STATE RD 7 | ||||||||
| Address2: | STE C | ||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544848850 | ||||||||
| FaxNumber: | 9544848851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME0014485 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 245925 | 01 | FL | AVMED | OTHER | 5883296 | 01 | FL | AETNA | OTHER | 78066 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 110716 | 01 | FL | HUMANA | OTHER | 061347900 | 05 | FL | MEDICAID |