Provider Demographics
NPI:1285647818
Name:HERRING, RANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:HERRING
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 1:204 E 16TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-4845
Mailing Address - Country:US
Mailing Address - Phone:806-244-1013
Mailing Address - Fax:806-244-1032
Practice Address - Street 1:204 E 16TH ST
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4845
Practice Address - Country:US
Practice Address - Phone:806-244-1013
Practice Address - Fax:806-244-1032
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096789502Medicaid
TX8A5754OtherBLUE CROSS BLUE SHIELD
TX115037102OtherFIRST CARE
TXG50663Medicare UPIN
TX096789502Medicaid
TX8A5754OtherBLUE CROSS BLUE SHIELD