Provider Demographics
NPI:1841578754
Name:STEPHANIE HERRERA, M.D AND ASSOCIATES, PA
Entity Type:Organization
Organization Name:STEPHANIE HERRERA, M.D AND ASSOCIATES, PA
Other - Org Name:LAKE JACKSON EAR, NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-299-1520
Mailing Address - Street 1:215 OAK DR S STE F
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5617
Mailing Address - Country:US
Mailing Address - Phone:979-299-1520
Mailing Address - Fax:979-299-1421
Practice Address - Street 1:215 OAK DR S STE F
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5617
Practice Address - Country:US
Practice Address - Phone:979-299-1520
Practice Address - Fax:979-299-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Y00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284422701Medicaid