Provider Demographics
NPI:1346249414
Name:HERR, VINCENT DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DEAN
Last Name:HERR
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:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0075
Mailing Address - Country:US
Mailing Address - Phone:541-882-1540
Mailing Address - Fax:541-882-2583
Practice Address - Street 1:7905 S 6TH STREET
Practice Address - Street 2:UNIT B
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603
Practice Address - Country:US
Practice Address - Phone:541-883-4573
Practice Address - Fax:541-883-4573
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17256207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037155Medicaid
ORF19083Medicare UPIN
OR103705Medicare ID - Type UnspecifiedMEDICARE RR
OR139111Medicare PIN
OR037155Medicaid