MEDICARE: DR. XAVIER HERRERA 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	DR.0047282	CO
2	207R00000X	Internal Medicine Physician	DR.0047282	CO

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	:	1912994526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XAVIER HERRERA MD

Provider Business Mailing Address
First Line	:	1106 E PROSPECT RD
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5304
Country	:	US
Telephone Number	:	970-495-7410
Fax Number	:	970-495-7425

Provider Business Practice Location Address
First Line	:	1106 E PROSPECT RD
Second Line	:	SUITE 100
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5304
Country	:	US
Telephone Number	:	970-495-7410
Fax Number	:	970-495-7425

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/21/2016

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