Provider Demographics
NPI:1154323681
Name:HERRON, JOEL BAIN (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:BAIN
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:925 N HAMILTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8708
Mailing Address - Country:US
Mailing Address - Phone:614-473-9519
Mailing Address - Fax:614-473-9543
Practice Address - Street 1:925 N HAMILTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8708
Practice Address - Country:US
Practice Address - Phone:614-473-9519
Practice Address - Fax:614-473-9543
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35078963207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418600Medicaid
H36982Medicare UPIN
OHHE4050692Medicare PIN