Provider Demographics
NPI:1437772308
Name:HERBST, AUSTIN GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GREGORY
Last Name:HERBST
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 1:241 W 11TH AVE STE 5082
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2356
Mailing Address - Country:US
Mailing Address - Phone:614-247-7701
Mailing Address - Fax:
Practice Address - Street 1:241 W 11TH AVE STE 5082
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2356
Practice Address - Country:US
Practice Address - Phone:614-247-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.254111390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program