Provider Demographics
NPI:1760679708
Name:VINCENT D HERR MD PC
Entity Type:Organization
Organization Name:VINCENT D HERR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-883-4573
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0075
Mailing Address - Country:US
Mailing Address - Phone:541-882-1540
Mailing Address - Fax:541-882-2583
Practice Address - Street 1:7905 S 6TH STREET UNIT B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7153
Practice Address - Country:US
Practice Address - Phone:541-883-4573
Practice Address - Fax:541-883-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037155Medicaid
ORF19083Medicare UPIN
OR037155Medicaid