Healthcare Provider Details

I. General information

NPI: 1154323681
Provider Name (Legal Business Name): JOEL BAIN HERRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N HAMILTON RD SUITE 100
GAHANNA OH
43230-8708
US

IV. Provider business mailing address

925 N HAMILTON RD SUITE 100
GAHANNA OH
43230-8708
US

V. Phone/Fax

Practice location:
  • Phone: 614-473-9519
  • Fax: 614-626-7774
Mailing address:
  • Phone: 614-473-9519
  • Fax: 614-473-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35078963
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: