Provider Demographics
NPI:1558396424
Name:HERRIN, VINCENT E (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:E
Last Name:HERRIN
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 1:2500 NORTH STATE STREET DIVISION OF HEMATOLOGY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5615
Mailing Address - Fax:601-984-5689
Practice Address - Street 1:1860 CHADWICK DR STE 351
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3472
Practice Address - Country:US
Practice Address - Phone:601-376-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14425207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1412074Medicaid
MS02450824Medicaid
MSP01236760OtherRAILROAD MEDICARE
AL103357Medicaid
MSP00327867Medicare PIN
MS302I837195Medicare PIN
MSH05403Medicare UPIN
LA1412074Medicaid
MS02450824Medicaid
MS512I830001Medicare PIN