Provider Demographics
NPI:1215934674
Name:HERRADA, JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:HERRADA
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:7848 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1815
Practice Address - Country:US
Practice Address - Phone:915-599-1313
Practice Address - Fax:915-599-1635
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2449207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K3572Medicaid
TX87788KMedicare PIN
TX85301FMedicare PIN
TXF47374Medicare UPIN