Provider Demographics
NPI:1285730747
Name:M. BOYD HERNDON, D.O., P.A.
Entity type:Organization
Organization Name:M. BOYD HERNDON, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANC CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-729-6401
Mailing Address - Street 1:886 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5607
Mailing Address - Country:US
Mailing Address - Phone:409-729-6401
Mailing Address - Fax:409-729-6015
Practice Address - Street 1:886 SIERRA DR
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5607
Practice Address - Country:US
Practice Address - Phone:409-729-6401
Practice Address - Fax:409-729-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9118207K00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00190XMedicare ID - Type Unspecified
TXA67085Medicare UPIN