Provider Demographics
NPI:1154524668
Name:HERRERA, RODOLFO ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ALBERTO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:571 W MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3667
Mailing Address - Country:US
Mailing Address - Phone:972-436-7531
Mailing Address - Fax:972-436-6114
Practice Address - Street 1:1305 AIRPORT FWY STE 302
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6604
Practice Address - Country:US
Practice Address - Phone:817-283-6995
Practice Address - Fax:817-952-7011
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3258208VP0014X, 207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine