Healthcare Provider Details

I. General information

NPI: 1497757041
Provider Name (Legal Business Name): MARTHA J. HERRING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA J FANNING

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EAST BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

1600 EAST BROADWAY
COLUMBIA MO
65201-5844
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8000
  • Fax: 573-815-8556
Mailing address:
  • Phone: 573-815-8000
  • Fax: 573-815-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005017819
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2005017819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: