Healthcare Provider Details

I. General information

NPI: 1508410846
Provider Name (Legal Business Name): HERRERA MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 AIRPORT FWY STE 302
BEDFORD TX
76021-6604
US

IV. Provider business mailing address

571 W MAIN ST STE 120
LEWISVILLE TX
75057-3667
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-6995
  • Fax: 817-952-7011
Mailing address:
  • Phone: 972-436-7531
  • Fax: 972-436-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODOLFO A HERRERA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 972-436-7531