MEDICARE: MR. ROBERT LEE HERROLD FNP

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	363LF0000X	Family Nurse Practitioner	R136851	MD

General Provider Information

NPI Number	:	1386634921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE HERROLD FNP

Provider Business Mailing Address
First Line	:	5130 SPRING ARROW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1821
Country	:	US
Telephone Number	:	210-295-4204
Fax Number	:

Provider Business Practice Location Address
First Line	:	TMC, MCWETHY
Second Line	:	FORT SAM HOUSTON
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-6000
Country	:	US
Telephone Number	:	210-295-4204
Fax Number	:

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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