MEDICARE: DR. GREGORY E HERBECK 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	208000000X	Pediatrics Physician	F1641	TX

General Provider Information

NPI Number	:	1699742338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY E HERBECK MD

Provider Business Mailing Address
First Line	:	PO BOX 847176
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7176
Country	:	US
Telephone Number	:	903-237-1800
Fax Number	:	903-237-1810

Provider Business Practice Location Address
First Line	:	707 HOLLYBROOK DR
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-2410
Country	:	US
Telephone Number	:	903-757-6042
Fax Number	:	903-232-8556

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	09/06/2012

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