Provider Demographics
NPI:1649295098
Name:HERBERT, PAMELA A (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:115 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-885-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70703207P00000X
IL036123497207P00000X
VA0101052384207P00000X
TXQ9637207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010401372Medicaid
TXP01761897OtherRAIL ROAD MEDICARE
TX365419602Medicaid
VA010401429Medicaid
VA010401348Medicaid
TX365419601Medicaid
TX75-0818167-044OtherTRICARE
TX8GJ705OtherBCBS
VA010401291Medicaid
TX8GJ704OtherBCBS
TX75-0818167-048OtherTRICARE
TX75-1976930-005OtherTRICARE
VA010401348Medicaid
TX542941YS6VMedicare PIN
TX365419601Medicaid
VA011274V21Medicare PIN
TX8GJ705OtherBCBS
F11174Medicare UPIN
VA010401372Medicaid