Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | G9118 | TX |
Y | 207YS0123X | Facial Plastic Surgeon | G9118 | TX |
NPI | 1235154758 |
---|---|
Provider Name | Dr. Milton Boyd Herndon |
First Address | Port Neches, TX 77651-5607 |
Second Address | Port Neches, TX 77651-5607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120264005 | (05) | TX |
168285801 | (05) | TX |
A67085 | (02) | TX |