Provider Demographics
NPI:1457326365
Name:HERDENER, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:HERDENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2706 S THIERMAN LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-5057
Mailing Address - Country:US
Mailing Address - Phone:509-456-8444
Mailing Address - Fax:509-455-9227
Practice Address - Street 1:120 S OLIVE AVE # 116
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5501
Practice Address - Country:US
Practice Address - Phone:561-223-6268
Practice Address - Fax:561-223-6239
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023695207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030170Medicaid
FLO1942OtherMEDICARE PTAN
WAA15510Medicare UPIN
WA070010541Medicare PIN