Healthcare Provider Details

I. General information

NPI: 1497753818
Provider Name (Legal Business Name): WILLIAM JOSEPH HERRON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 LYNN LANE
IDABEL OK
74745
US

IV. Provider business mailing address

1315 S LYNN LN
IDABEL OK
74745-6845
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-3328
  • Fax: 580-286-2444
Mailing address:
  • Phone: 580-206-2947
  • Fax: 855-517-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2097
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: