Healthcare Provider Details

I. General information

NPI: 1710957782
Provider Name (Legal Business Name): HERSCHEL R HARTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

4864 JACKSON ST
MONROE LA
71202-6400
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7626
  • Fax: 318-330-7648
Mailing address:
  • Phone: 318-330-7626
  • Fax: 318-330-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number06283R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: