Provider Demographics
NPI:1508078452
Name:HERRERA MEDICAL GROUP OF BEDFORD & ASSOCIATES
Entity Type:Organization
Organization Name:HERRERA MEDICAL GROUP OF BEDFORD & ASSOCIATES
Other - Org Name:YOUR FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-283-6995
Mailing Address - Street 1:1305 AIRPORT FWY STE 302A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6604
Mailing Address - Country:US
Mailing Address - Phone:817-283-6995
Mailing Address - Fax:817-283-2397
Practice Address - Street 1:1305 AIRPORT FREEWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-283-6995
Practice Address - Fax:817-283-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154524668OtherNPPES
TX2018434-05Medicaid