Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M3258 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | M3258 | TX |
NPI | 1154524668 |
---|---|
Provider Name | Dr. Rodolfo Alberto Herrera |
First Address | Lewisville, TX 75057-3667 |
Second Address | Bedford, TX 76021-6604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 21/07/2020 |