Provider Demographics
NPI:1760632004
Name:W RICHARD HERBERT MD PS
Entity Type:Organization
Organization Name:W RICHARD HERBERT MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-758-5527
Mailing Address - Street 1:617 DIAGONAL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2041
Mailing Address - Country:US
Mailing Address - Phone:509-758-5527
Mailing Address - Fax:509-758-5122
Practice Address - Street 1:617 DIAGONAL ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2041
Practice Address - Country:US
Practice Address - Phone:509-758-5527
Practice Address - Fax:509-758-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010970207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty