Provider Demographics
NPI:1215957873
Name:HERBERT, DAVID CHARLES (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:HERBERT
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 1:1842 SOUTH CONCHO DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7970
Mailing Address - Country:US
Mailing Address - Phone:325-942-1972
Mailing Address - Fax:325-224-3326
Practice Address - Street 1:1842 SOUTH CONCHO DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7970
Practice Address - Country:US
Practice Address - Phone:325-942-1972
Practice Address - Fax:325-224-3326
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5330207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP085220J3Medicaid
TXB23451Medicare UPIN