Individual
JOHN L HERZOG SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1421 E UNION ST, GREENVILLE, MS 38703-3247
(662) 335-0183
(662) 335-7184
Mailing address
PO BOX 5368, GREENVILLE, MS 38704-5368
(662) 394-0107
(662) 335-7184
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
09800
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123017
—
MS
01
—
060000624
MEDICARE
MS
05
—
126236001
—
AR
Enumeration date
07/19/2006
Last updated
08/21/2020
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