Provider Demographics
NPI:1851575658
Name:CHARLES HERRERA M.D.,P.A.
Entity Type:Organization
Organization Name:CHARLES HERRERA M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-720-8036
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-443-7600
Mailing Address - Fax:954-443-7555
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-443-7600
Practice Address - Fax:954-443-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054912207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3056Medicare PIN