Provider Demographics
NPI:1629044169
Name:HERBERT, KENT STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:STEVEN
Last Name:HERBERT
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 1:7641 MCLAUGHLIN RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4715
Mailing Address - Country:US
Mailing Address - Phone:719-494-2006
Mailing Address - Fax:719-494-8448
Practice Address - Street 1:7641 MCLAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4715
Practice Address - Country:US
Practice Address - Phone:719-494-2006
Practice Address - Fax:719-494-8448
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038941207Q00000X
CO44396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine