Healthcare Provider Details

I. General information

NPI: 1982782181
Provider Name (Legal Business Name): PATRICK SCOTT HERD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHWEST CENTER FOR BEHAVIORAL HEALTH 1 MILE EAST ON HWY 270
FORT SUPPLY OK
73841
US

IV. Provider business mailing address

1222 10TH ST SUITE 211
WOODWARD OK
73801-3156
US

V. Phone/Fax

Practice location:
  • Phone: 580-766-2311
  • Fax:
Mailing address:
  • Phone: 580-766-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18233
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: