Provider Demographics
NPI:1609959535
Name:RALPH D. HERBIG, DO, LTD
Entity Type:Organization
Organization Name:RALPH D. HERBIG, DO, LTD
Other - Org Name:HERBIG FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBIG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-782-4030
Mailing Address - Street 1:1540 HIGHWAY 395
Mailing Address - Street 2:SUITE E
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410
Mailing Address - Country:US
Mailing Address - Phone:775-782-4030
Mailing Address - Fax:775-782-6430
Practice Address - Street 1:1540 HIGHWAY 395
Practice Address - Street 2:SUITE E
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:775-782-4030
Practice Address - Fax:775-782-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506800Medicaid
NV101772Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER