Provider Demographics
NPI:1447291158
Name:HERRIN, JAMES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:HERRIN
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 1:13276 CHAPPEL WOOD LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3477
Mailing Address - Country:US
Mailing Address - Phone:936-441-2314
Mailing Address - Fax:936-788-6061
Practice Address - Street 1:333 N RIVERSHIRE DR
Practice Address - Street 2:SUITE # 190
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-0001
Practice Address - Country:US
Practice Address - Phone:936-788-6060
Practice Address - Fax:936-788-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020MHOtherBLUECROSS/BLUE SHIELD
TX4204684OtherAETNA #
TX0020MHOtherBLUECROSS/BLUE SHIELD