Provider Demographics
NPI:1942271812
Name:HERRON, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7260 HALCYON SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7047
Mailing Address - Country:US
Mailing Address - Phone:334-277-3332
Mailing Address - Fax:334-277-3522
Practice Address - Street 1:7260 HALCYON SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7047
Practice Address - Country:US
Practice Address - Phone:334-277-3332
Practice Address - Fax:334-277-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL21157207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923240Medicaid
AL529923240Medicaid
AL515-27852Medicare ID - Type Unspecified