Provider Demographics
NPI:1609803048
Name:BAZRON, HERBERT CHARLES JR (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:CHARLES
Last Name:BAZRON
Suffix:JR
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 1:1100 TRANCAS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2904
Mailing Address - Country:US
Mailing Address - Phone:707-703-4863
Mailing Address - Fax:707-257-4116
Practice Address - Street 1:1100 TRANCAS ST STE 201
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2904
Practice Address - Country:US
Practice Address - Phone:707-703-4863
Practice Address - Fax:707-257-4116
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034000E207R00000X
CAG159334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010868320001Medicaid
PA0010868320001Medicaid
B35190Medicare UPIN