Provider Demographics
NPI:1730109968
Name:HERRON, LARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:HERRON
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 1:1551 BISHOP ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4665
Mailing Address - Country:US
Mailing Address - Phone:805-541-4700
Mailing Address - Fax:805-541-4713
Practice Address - Street 1:1551 BISHOP ST STE 510
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4665
Practice Address - Country:US
Practice Address - Phone:805-541-4700
Practice Address - Fax:805-541-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25538207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25538OtherMEDICAL LICENSE
CAAH5742451OtherDEA NUMBER
CAAH5742451OtherDEA NUMBER
CAAH5742451OtherDEA NUMBER
CAW19383Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER