Provider Demographics
NPI:1588628671
Name:HERRERA, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
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 1:6037 KIMBERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2811
Mailing Address - Country:US
Mailing Address - Phone:954-379-8994
Mailing Address - Fax:954-977-2711
Practice Address - Street 1:6037 KIMBERLY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2811
Practice Address - Country:US
Practice Address - Phone:954-379-8994
Practice Address - Fax:954-977-2711
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054912207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07994Medicare ID - Type UnspecifiedMEDICARE