Provider Demographics
NPI:1497753818
Name:HERRON, WILLIAM JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:HERRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 LYNN LANE
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-5234
Mailing Address - Country:US
Mailing Address - Phone:580-286-3328
Mailing Address - Fax:580-286-2444
Practice Address - Street 1:1315 LYNN LANE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745
Practice Address - Country:US
Practice Address - Phone:580-286-3328
Practice Address - Fax:580-286-2444
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106700CMedicaid
OKE15974Medicare UPIN