Provider Demographics
NPI:1447433032
Name:ROY L HERNDON MD INC
Entity Type:Organization
Organization Name:ROY L HERNDON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-6042
Mailing Address - Street 1:1010 W LAVETA AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4200
Mailing Address - Country:US
Mailing Address - Phone:714-835-6042
Mailing Address - Fax:714-835-5135
Practice Address - Street 1:1010 W LAVETA AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4200
Practice Address - Country:US
Practice Address - Phone:714-835-6042
Practice Address - Fax:714-835-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA19659Medicare PIN