Provider Demographics
NPI:1679766943
Name:HERRON, KYLE A (MD)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:A
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1890 LPGA BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7207
Mailing Address - Country:US
Mailing Address - Phone:386-282-3524
Mailing Address - Fax:386-265-4197
Practice Address - Street 1:1890 LPGA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7207
Practice Address - Country:US
Practice Address - Phone:386-282-3524
Practice Address - Fax:386-265-4197
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 182598208600000X
PAMT182598208600000X
TXN75462086S0105X
GA0766072086S0105X
FLME142276208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand