Healthcare Provider Details

I. General information

NPI: 1215564372
Provider Name (Legal Business Name): FERNANDO MAGANA HERRERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E BROAD ST STE 304
MANSFIELD TX
76063-6412
US

IV. Provider business mailing address

2800 E BROAD ST STE 304
MANSFIELD TX
76063-6412
US

V. Phone/Fax

Practice location:
  • Phone: 817-477-5500
  • Fax: 817-453-5503
Mailing address:
  • Phone: 817-477-5500
  • Fax: 817-453-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberW6299
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: