Provider Demographics
NPI:1609166347
Name:HERNDON, GRANT WHITTINGTON (DO)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:WHITTINGTON
Last Name:HERNDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 PLEASANT HILL RD.
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8555
Mailing Address - Country:US
Mailing Address - Phone:409-720-8147
Mailing Address - Fax:
Practice Address - Street 1:2724 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8555
Practice Address - Country:US
Practice Address - Phone:409-720-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program