Provider Demographics
NPI:1073947495
Name:HARRIS-HERRON, ERICA (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HARRIS-HERRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3878 PERSHALL RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1246
Mailing Address - Country:US
Mailing Address - Phone:314-839-7500
Mailing Address - Fax:
Practice Address - Street 1:3878 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1246
Practice Address - Country:US
Practice Address - Phone:314-839-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 126938208000000X
MO2022026679208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics