Provider Demographics
NPI:1710914114
Name:HERRERA, MOSES (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:
Last Name:HERRERA
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 1:606 ROARING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3945
Mailing Address - Country:US
Mailing Address - Phone:469-878-6953
Mailing Address - Fax:
Practice Address - Street 1:606 ROARING CREEK CT
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3945
Practice Address - Country:US
Practice Address - Phone:469-878-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130924707Medicaid
TX8D9414Medicare ID - Type Unspecified
TXF54559Medicare UPIN