Healthcare Provider Details

I. General information

NPI: 1700272648
Provider Name (Legal Business Name): JOSEPH HERRON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3466 PINE RIDGE RD STE A
NAPLES FL
34109-3883
US

IV. Provider business mailing address

3466 PINE RIDGE RD STE A
NAPLES FL
34109-3883
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-2663
  • Fax:
Mailing address:
  • Phone: 239-261-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME151450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: