Provider Demographics
NPI:1124077003
Name:HERRERA -BEHR, LUIS FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:FERNANDO
Last Name:HERRERA -BEHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:FERNANDO
Other - Last Name:HERRERA BEHR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4584 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1919
Mailing Address - Country:US
Mailing Address - Phone:352-592-1191
Mailing Address - Fax:352-592-1191
Practice Address - Street 1:4584 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1919
Practice Address - Country:US
Practice Address - Phone:352-592-1191
Practice Address - Fax:352-592-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274603400Medicaid
H23540Medicare UPIN
FLU6491Medicare ID - Type Unspecified