Provider Demographics
NPI:1306800941
Name:HERRERA, LARRY C (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:
Practice Address - Street 1:1602 HILL ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-2525
Practice Address - Country:US
Practice Address - Phone:512-772-4887
Practice Address - Fax:877-583-4093
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427767208000000X
NJMA08356500208000000X, 208D00000X, 208M00000X
TXJ2075208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18155Medicare UPIN