Provider Demographics
NPI:1760451660
Name:HERBER, MATT E (MD)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:E
Last Name:HERBER
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 1:111 10TH STREET E
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1208
Mailing Address - Country:US
Mailing Address - Phone:605-428-5446
Mailing Address - Fax:
Practice Address - Street 1:111 10TH STREET E
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1208
Practice Address - Country:US
Practice Address - Phone:605-428-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611290Medicaid
SD0040598OtherWELLMARK BCBS OF SD
237207OtherMIDLANDS CHOICE
SD4996051OtherWELLMARK BCBS OF SD
SD5054OtherDAKOTACARE
AH9021031595OtherPREFERRED ONE
SD5611292Medicaid
57022A012OtherTRICARE
MN70R64HEOtherBCBS OF MN
1675123OtherAMERICAS PPO
MN397140600Medicaid
57022A012OtherTRICARE
SDS40598Medicare PIN
SD5611290Medicaid