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General NPI Number Information
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NPI Number | 1710203955
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Entity Type | Individual
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Provider Name | BARON VANCE HERFORD D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | COOKEVILLE
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State | TN
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Zip | 38501-4294
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Country | US
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Telephone | 931-372-2770
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Fax | 931-525-1176
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Provider Business Mailing Address
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Address Line | 401 ALCORN DR SUITE 2C
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City | CORINTH
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State | MS
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Zip | 38834-9072
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Country | US
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Telephone | 662-286-9255
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Fax | 662-286-9274
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20998
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2847
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License Number State | TN
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