Healthcare Provider Details

I. General information

NPI: 1962487389
Provider Name (Legal Business Name): LEON W HERRING PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 SW 6TH AVE SUITE 200
TOPEKA KS
66615
US

IV. Provider business mailing address

6001 SW 6TH AVE SUITE 200
TOPEKA KS
66615
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-7491
  • Fax: 785-233-3187
Mailing address:
  • Phone: 785-233-7491
  • Fax: 785-233-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1500159
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: