Healthcare Provider Details

I. General information

NPI: 1801849906
Provider Name (Legal Business Name): THOMAS HEROLD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW H K DODGEN LOOP
TEMPLE TX
76502-1814
US

IV. Provider business mailing address

1917 CHASEWOOD DR
AUSTIN TX
78727-6373
US

V. Phone/Fax

Practice location:
  • Phone: 254-771-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberM1141
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: