Provider Demographics
NPI:1881624344
Name:HERRON, NORMAN C (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:C
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DR
Mailing Address - Street 2:#452
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4691
Mailing Address - Country:US
Mailing Address - Phone:907-562-2120
Mailing Address - Fax:907-562-6527
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:#452
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4691
Practice Address - Country:US
Practice Address - Phone:907-562-2120
Practice Address - Fax:907-562-6527
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3147208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1011284Medicaid
AKMD2239Medicaid
AKK150413Medicare PIN