Individual
DR. JACQUES A HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
450 N NEW BALLAS RD, DEPT OTOLARYNGOLOGY, STE 140, SAINT LOUIS, MO 63141-6859
(314) 362-7509
(314) 453-0561
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-7509
(314) 453-0561
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
R7F68
MO
207YX0901X
Otology & Neurotology Physician
Primary
R7F68
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202326427
—
MO
Enumeration date
07/18/2005
Last updated
04/17/2025
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