MEDICARE: CHARLES L HERRING M.D.

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G84865	CA
2	207X00000X	Orthopaedic Surgery Physician	G84865	CA

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

General Provider Information

NPI Number	:	1831231927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES L HERRING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9789
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90295-2189
Country	:	US
Telephone Number	:	310-577-8500
Fax Number	:	310-305-7119

Provider Business Practice Location Address
First Line	:	8930 S SEPULVEDA BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3624
Country	:	US
Telephone Number	:	310-641-8111
Fax Number	:	310-337-7274

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/17/2018

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Directions to “ CHARLES L HERRING M.D.” Practice Location

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