Provider Demographics
NPI:1326064825
Name:HERREN, MARCOM EARL (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCOM
Middle Name:EARL
Last Name:HERREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MAPLEWOOD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3879
Mailing Address - Country:US
Mailing Address - Phone:940-696-8500
Mailing Address - Fax:940-696-8546
Practice Address - Street 1:4301 MAPLEWOOD AVE
Practice Address - Street 2:STE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3879
Practice Address - Country:US
Practice Address - Phone:940-696-8500
Practice Address - Fax:940-696-8546
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH99882081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO80Y0218Medicaid
TXF57208Medicare UPIN
TXPO80Y0218Medicaid