Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 16841 | TX |
Y | 213EG0000X | General Practice | 16841 | TX |
NPI | 1003815614 |
---|---|
Provider Name | Dr. Gary Robert Herron II |
First Address | Austin, TX 78727-4539 |
Second Address | Austin, TX 78723-1134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 08/07/2007 |