Provider Demographics
NPI:1174501597
Name:HERRERA, ESMERALDO DIAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ESMERALDO
Middle Name:DIAZ
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JV MANGUBAT DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2440
Mailing Address - Country:US
Mailing Address - Phone:931-722-9999
Mailing Address - Fax:931-722-2049
Practice Address - Street 1:101 JV MANGUBAT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2440
Practice Address - Country:US
Practice Address - Phone:931-722-9999
Practice Address - Fax:931-722-2049
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25806207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3085092Medicaid
TN3710089Medicaid
TN3085097Medicaid
TNF89315Medicare UPIN