Provider Demographics
NPI:1598935033
Name:RANDY DWAYNE HERRING MD PA
Entity Type:Organization
Organization Name:RANDY DWAYNE HERRING MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-244-1013
Mailing Address - Street 1:204 E 16TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-4845
Mailing Address - Country:US
Mailing Address - Phone:806-244-1013
Mailing Address - Fax:806-244-1032
Practice Address - Street 1:204 E 16TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4845
Practice Address - Country:US
Practice Address - Phone:806-244-1013
Practice Address - Fax:806-244-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
115037102OtherFIRST CARE
0062BSOtherBCBS
080112685OtherMEDICARE RAILROAD
677202OtherCAMBRIDGE
TX096789502Medicaid
TX096789502Medicaid
677202OtherCAMBRIDGE