Provider Demographics
NPI:1134139595
Name:HERR, MARC WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:WILLIAM
Last Name:HERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1608 S J ST FL 5
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-426-6731
Mailing Address - Fax:253-382-8174
Practice Address - Street 1:1608 S J ST FL 5
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-426-6731
Practice Address - Fax:253-382-8174
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60909611207YX0007X, 207Y00000X
HIMD-13459207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1134139595Medicaid
WA2120946Medicaid