Provider Demographics
NPI:1942294483
Name:HERNDON, ERIN KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KIMBERLY
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4190
Mailing Address - Country:US
Mailing Address - Phone:563-355-9200
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:221 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2241
Practice Address - Country:US
Practice Address - Phone:563-242-7522
Practice Address - Fax:563-242-7534
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA24246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA03108Medicare UPIN