Healthcare Provider Details

I. General information

NPI: 1942272000
Provider Name (Legal Business Name): FERNANDO A HERRERA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 WALNUT GROVE RD STE 318
MEMPHIS TN
38120-2145
US

IV. Provider business mailing address

6027 WALNUT GROVE RD STE 318
MEMPHIS TN
38120-2145
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-1181
  • Fax: 901-761-0589
Mailing address:
  • Phone: 901-761-1181
  • Fax: 901-761-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number010543
License Number StateTN

VIII. Authorized Official

Name: DR. FERNANDO A HERRERA
Title or Position: PRESIDENT
Credential: MD
Phone: 901-761-1181