Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 11337 | TN |
NPI | 1639135361 |
---|---|
Provider Name | Dr. Henry G Herrod |
First Address | Memphis, TN 38105-5105 |
Second Address | Memphis, TN 38132-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 27/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3177332 | (05) | TN |
B03761 | (02) |