Individual
MR. ROBERT HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002116
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086861
HAMP INS. NUMBER
IL
01
—
3932056
BCBS OF IL
IL
01
—
619456
HEALTHLINK
IL
01
—
7210895
AETNA
IL
Enumeration date
01/02/2007
Last updated
10/13/2023
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