Provider Demographics
NPI:1033103841
Name:HERD, ANTHONY JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOHN
Last Name:HERD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3933 UP RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-3020
Mailing Address - Country:US
Mailing Address - Phone:361-882-1001
Mailing Address - Fax:361-882-1040
Practice Address - Street 1:9929 S PADRE ISLAND DR STE 109
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5148
Practice Address - Country:US
Practice Address - Phone:361-937-2121
Practice Address - Fax:718-640-2713
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01865363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
304288YNNNMedicare PIN