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General NPI Number Information
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NPI Number | 1124009501
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Entity Type | Individual
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Provider Name | VIRGLE O. HERRIN JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 300 W COUNTRY CLUB RD STE 210
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City | ROSWELL
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State | NM
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Zip | 88201-5240
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Country | US
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Telephone | 575-625-1292
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Fax | 575-624-4836
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Provider Business Mailing Address
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Address Line | 300 W COUNTRY CLUB RD STE 210
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City | ROSWELL
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State | NM
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Zip | 88201-5240
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Country | US
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Telephone | 575-625-1292
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Fax | 575-624-4836
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 80-44
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME107006
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD203548
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 80-44
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 80-44
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License Number State | NM
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