Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | H9988 | TX |
NPI | 1326064825 |
---|---|
Provider Name | Dr. Marcom Earl Herren |
First Address | Wichita Falls, TX 76308-3879 |
Second Address | Wichita Falls, TX 76308-3879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F57208 | (02) | TX |
PO80Y0218 | (05) | TX |