Provider Demographics
NPI:1497738645
Name:HERBERT, JAMES WALDO (M D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALDO
Last Name:HERBERT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3018 PALO DURO DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7433
Mailing Address - Country:US
Mailing Address - Phone:325-949-8671
Mailing Address - Fax:325-658-6500
Practice Address - Street 1:314 E TWOHIG AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5502
Practice Address - Country:US
Practice Address - Phone:325-653-6944
Practice Address - Fax:325-658-6500
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD94922080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JT67OtherBLUE CROSS ID
TX130369502Medicaid
TX130369502Medicaid
TXE77675Medicare UPIN