MEDICARE: JOHN JOSEPH HERBST 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	2080P0206X	Pediatric Gastroenterology Physician	06671R	LA

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	:	1962422980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH HERBST M.D.

Provider Business Mailing Address
First Line	:	1501 KINGS HWY
Second Line	:	DEPARTMENT OF PEDIATRICS, SECTION OF GASTROENTEROLOGY
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-675-8601
Fax Number	:	318-813-8872

Provider Business Practice Location Address
First Line	:	1501 KINGS HWY
Second Line	:	DEPARTMENT OF PEDIATRICS, SECTION OF GASTROENTEROLOGY
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-675-8601
Fax Number	:	318-813-8872

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/15/2026

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