Individual
JEFFERY SCOTT HERRIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
18606 ERVIN ST, WHITEHALL, WI 54773-8613
(715) 538-4355
Mailing address
18601 LINCOLN ST, WHITEHALL, WI 54773-8605
(715) 538-1712
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1211
WI
363AM0700X
Medical Physician Assistant
1211
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42991300
—
WI
Enumeration date
06/20/2005
Last updated
03/19/2019
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