MEDICARE: DR. ALLEN J HERBERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD 010285	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	720972556	OTHER	LA	TRICARE

General Provider Information

NPI Number	:	1003863234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN J HERBERT MD

Provider Business Mailing Address
First Line	:	PO BOX 1768
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71166-1768
Country	:	US
Telephone Number	:	318-677-7450
Fax Number	:	318-425-5815

Provider Business Practice Location Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 203
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-255-7474
Fax Number	:	318-425-2335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/12/2009

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