MEDICARE: JING XU HERWIG 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	94-10705	KS

General Provider Information

NPI Number	:	1265052674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JING XU HERWIG MD

Provider Business Mailing Address
First Line	:	2603 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2628
Country	:	US
Telephone Number	:	405-378-5752
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2628
Country	:	US
Telephone Number	:	405-378-5752
Fax Number	:	405-378-5753

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

Provider Enumeration Date	:	04/26/2020
Last Update Date	:	09/19/2024

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