Healthcare Provider Details

I. General information

NPI: 1295295640
Provider Name (Legal Business Name): JOSHUA HERRING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 12/23/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 99 UNIT 5024 MISAWA AIR BASE
APO AP
96319-0068
US

IV. Provider business mailing address

BUILDING 99 UNIT 5024 MISAWA AIR BASE
APO AP
96319-0068
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6133
  • Fax:
Mailing address:
  • Phone: 315-226-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020036789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: