Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | LP01983 | RI |
N | 208600000X | Surgeon | LP01983 | RI |
Y | 208200000X | Surgeon | ME123997 | FL |
Y | 208600000X | Surgeon | ME123997 | FL |
NPI | 1013237007 |
---|---|
Provider Name | Thomas J Herron |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015292500 | (05) | FL |
151KN | BLUE CROSS BLUE SHIELD (01) | FL |