Healthcare Provider Details

I. General information

NPI: 1306800941
Provider Name (Legal Business Name): LARRY C HERRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LARRY HERRERA M.D.

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 HILL ST
BASTROP TX
78602-2525
US

IV. Provider business mailing address

PO BOX 1890
GONZALES TX
78629-1390
US

V. Phone/Fax

Practice location:
  • Phone: 512-772-4887
  • Fax: 877-583-4093
Mailing address:
  • Phone: 830-672-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD427767
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA08356500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMA08356500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMA08356500
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ2075
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: