Healthcare Provider Details

I. General information

NPI: 1154524668
Provider Name (Legal Business Name): RODOLFO ALBERTO HERRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
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 Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM3258
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberM3258
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: