Provider Demographics
NPI:1245534064
Name:HERRERA, STEPHANIE JO (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JO
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 OAK DR S
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5629
Mailing Address - Country:US
Mailing Address - Phone:979-299-1520
Mailing Address - Fax:979-299-1421
Practice Address - Street 1:215 OAK DR S
Practice Address - Street 2:SUITE F
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5629
Practice Address - Country:US
Practice Address - Phone:979-299-1520
Practice Address - Fax:979-299-1421
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8304207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284422701Medicaid
TXTXB132147Medicare PIN