Provider Demographics
NPI:1831194679
Name:HERRINGTON, RONALD GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:GLENN
Other - Last Name:HERRINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N STATE ST STE 330
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2027
Mailing Address - Country:US
Mailing Address - Phone:601-353-2020
Mailing Address - Fax:601-714-5110
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:STE 403
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-353-2020
Practice Address - Fax:601-714-5110
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11733207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944551Medicaid
MS00110680Medicaid
AL009976295Medicaid
MS180039807Medicare ID - Type UnspecifiedMEDICARE RAILROAD
AL009976295Medicaid
MSE96180Medicare UPIN