Provider Demographics
NPI:1518209238
Name:HERRERA, JAIME ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ROBERTO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 YALE ST APT 341
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2844
Mailing Address - Country:US
Mailing Address - Phone:631-258-3147
Mailing Address - Fax:
Practice Address - Street 1:5230 ALDINE MAIL RTE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3804
Practice Address - Country:US
Practice Address - Phone:281-598-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics