Provider Demographics
NPI:1821022484
Name:HERROD, JOHN N (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:HERROD
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 1:286 S. LENZNER AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2821
Mailing Address - Country:US
Mailing Address - Phone:520-452-0388
Mailing Address - Fax:520-452-0379
Practice Address - Street 1:286 S LENZNER AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5685
Practice Address - Country:US
Practice Address - Phone:520-452-0388
Practice Address - Fax:520-452-0379
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ322181Medicaid
AZ322181Medicaid
AZC63883Medicare UPIN