MEDICARE: M. BOYD HERNDON, D.O., P.A.

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

General Provider Information

NPI Number	:	1285730747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. BOYD HERNDON, D.O., P.A.

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

Authorized Official
Title or Position	:	INSURANC CLERK
Name	:	MRS. LORI A RICE
Credential	:
Telephone Number	:	409-729-6401

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	09/11/2025

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