Provider Demographics
NPI:1912994526
Name:HERRERA, XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:
Last Name:HERRERA
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 1:1106 E PROSPECT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5304
Mailing Address - Country:US
Mailing Address - Phone:970-495-7410
Mailing Address - Fax:970-495-7425
Practice Address - Street 1:1106 E PROSPECT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5304
Practice Address - Country:US
Practice Address - Phone:970-495-7410
Practice Address - Fax:970-495-7425
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0047282207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09856315Medicaid
COP01204118Medicare PIN
COC0304192Medicare PIN
CO09856315Medicaid
I17539Medicare UPIN
NM343428100Medicare PIN
CO09856315Medicaid
COP01204118Medicare PIN