Healthcare Provider Details

I. General information

NPI: 1285647818
Provider Name (Legal Business Name): RANDY HERRING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 16TH ST
DALHART TX
79022-4845
US

IV. Provider business mailing address

204 E 16TH ST STE B
DALHART TX
79022-4845
US

V. Phone/Fax

Practice location:
  • Phone: 806-244-1013
  • Fax: 806-244-1032
Mailing address:
  • Phone: 806-244-1013
  • Fax: 806-244-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: