Provider Demographics
NPI:1356323729
Name:HERRON, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 TYLER ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3316
Mailing Address - Country:US
Mailing Address - Phone:419-626-6362
Mailing Address - Fax:419-626-6344
Practice Address - Street 1:703 TYLER ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3316
Practice Address - Country:US
Practice Address - Phone:419-626-6362
Practice Address - Fax:419-626-6344
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350509852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0727155Medicaid
9246341Medicare ID - Type Unspecified
OH0727155Medicaid