MEDICARE: DR. MILTON BOYD HERNDON DO PA

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	207YS0123X	Facial Plastic Surgery Physician	G9118	TX
2	207K00000X	Allergy & Immunology Physician	G9118	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235154758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILTON BOYD HERNDON DO PA

Provider Business Mailing Address
First Line	:	886 SIERRA DR
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5607
Country	:	US
Telephone Number	:	406-729-6401
Fax Number	:	409-729-6015

Provider Business Practice Location Address
First Line	:	886 SIERRA DR
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5607
Country	:	US
Telephone Number	:	406-729-6401
Fax Number	:	409-729-6015

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/09/2014

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Directions to “ DR. MILTON BOYD HERNDON DO PA” Practice Location

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