Provider Demographics
NPI:1497757041
Name:HERRING, MARTHA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:HERRING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:J
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 EAST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5844
Mailing Address - Country:US
Mailing Address - Phone:573-815-8000
Mailing Address - Fax:573-815-8556
Practice Address - Street 1:1605 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-8000
Practice Address - Fax:573-815-8556
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017819207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
720350OtherHEALTHLINK
199366OtherBCBS
MO207578808Medicaid
MOP00308830OtherRAILROAD MEDICARE
720350OtherHEALTHLINK
MO207578808Medicaid