Healthcare Provider Details

I. General information

NPI: 1538402938
Provider Name (Legal Business Name): ROBERT DEAN HERRON III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE ROOM 3032
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

7 PINEWOOD DR
WHEELING WV
26003-9306
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-9948
  • Fax:
Mailing address:
  • Phone: 304-280-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number3289
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: