Provider Demographics
NPI:1942272000
Name:FERNANDO A HERRERA MD PC
Entity Type:Organization
Organization Name:FERNANDO A HERRERA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-1181
Mailing Address - Street 1:6027 WALNUT GROVE RD
Mailing Address - Street 2:STE 318
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2145
Mailing Address - Country:US
Mailing Address - Phone:901-761-1181
Mailing Address - Fax:901-761-0589
Practice Address - Street 1:6027 WALNUT GROVE RD
Practice Address - Street 2:STE 318
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2145
Practice Address - Country:US
Practice Address - Phone:901-761-1181
Practice Address - Fax:901-761-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN010543208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3701537Medicaid
TN3701537Medicare ID - Type Unspecified
B03364Medicare UPIN
TN3701537Medicaid