Provider Demographics
NPI:1770995862
Name:HERRETES, SAMANTHA P (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:P
Last Name:HERRETES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:4320 WORNALL RD STE 220
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:913-261-2020
Practice Address - Fax:913-261-2090
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2021-10-20
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Provider Licenses
StateLicense IDTaxonomies
MO2018011188207WX0108X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease