Healthcare Provider Details

I. General information

NPI: 1215012299
Provider Name (Legal Business Name): SAMUEL B HERRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 24TH ST
LUBBOCK TX
79410-1894
US

IV. Provider business mailing address

3420 22ND PL
LUBBOCK TX
79410-1314
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-0030
  • Fax:
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL8728
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: