Individual
MARK HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
924 N HOWE ST, SOUTHPORT, NC 28461-3038
(910) 454-4703
Mailing address
7704 TRAP WAY, WILMINGTON, NC 28412-3450
(910) 452-5156
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
3211
NC
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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