Provider Demographics
NPI:1760062640
Name:HERRON, KURTIS ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:ROBERT
Last Name:HERRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W GROVE PKWY APT 386
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4418
Mailing Address - Country:US
Mailing Address - Phone:620-249-1438
Mailing Address - Fax:
Practice Address - Street 1:1155 W GROVE PKWY APT 386
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4418
Practice Address - Country:US
Practice Address - Phone:620-249-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program