Provider Demographics
NPI:1740945484
Name:HERROD, BRENDEN JOHN (MD)
Entity type:Individual
Prefix:
First Name:BRENDEN
Middle Name:JOHN
Last Name:HERROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 S COULTER ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1786
Mailing Address - Country:US
Mailing Address - Phone:806-414-9559
Mailing Address - Fax:
Practice Address - Street 1:1400 S COULTER ST STE 5100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9559
Practice Address - Fax:806-351-3765
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10080341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine