Provider Demographics
NPI:1831183805
Name:HERRON, STEVEN JOHN (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOHN
Last Name:HERRON
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 1:1111 LAS TABLAS RD
Mailing Address - Street 2:STE N
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9732
Mailing Address - Country:US
Mailing Address - Phone:805-434-1825
Mailing Address - Fax:805-434-2761
Practice Address - Street 1:1111 LAS TABLAS RD
Practice Address - Street 2:STE N
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9732
Practice Address - Country:US
Practice Address - Phone:805-434-1825
Practice Address - Fax:805-434-2761
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG55433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G554331Medicaid
CAG55433Medicare ID - Type Unspecified
CA00G554331Medicaid