=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215476346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RODOLFO A HERRERA MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2017
-----------------------------------------------------
Last Update Date | 02/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1116 BOURLAND RD
-----------------------------------------------------
City | KELLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76248-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-209-4110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 AIRPORT FWY STE 302
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-6604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-209-4110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RODOLFO A HERRERA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 817-209-4110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | M3258
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------