Provider Demographics
NPI:1215923453
Name:HERRING, LATRECIA M (MD)
Entity type:Individual
Prefix:DR
First Name:LATRECIA
Middle Name:M
Last Name:HERRING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 N CAMINO MERCADO
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5759
Mailing Address - Country:US
Mailing Address - Phone:520-836-5538
Mailing Address - Fax:520-836-6998
Practice Address - Street 1:560 N CAMINO MERCADO
Practice Address - Street 2:SUITE 7
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5759
Practice Address - Country:US
Practice Address - Phone:520-836-5538
Practice Address - Fax:520-836-6998
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34157207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ972613Medicaid
AZ115849Medicare PIN
AZ972613Medicaid
AZP00445500Medicare PIN