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NPI Code Detail

MEDICARE: SAMANTHA P. HERRETES MD

MEDICARE: SAMANTHA P. HERRETES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207WX0120XCornea and External Diseases Specialist Physician2018011188MO
2207W00000XOphthalmology Physician2018011188MO
3207WX0108XUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician2018011188MO
4207WX0120XCornea and External Diseases Specialist Physician04-42495KS

General Provider Information

NPI Number : 1770995862
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA P. HERRETES MD
Provider Business Mailing Address
First Line : PO BOX 843966
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-3966
Country : US
Telephone Number : 573-884-3300
Fax Number : 573-884-0943
Provider Business Practice Location Address
First Line : 3215 WINGATE CT STE 102
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-7689
Country : US
Telephone Number : 573-884-3937
Fax Number : 573-884-4868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2014
Last Update Date : 01/14/2026

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