Provider Demographics
NPI:1528176690
Name:HERNDON, DAVID NEWCOMB (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NEWCOMB
Last Name:HERNDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:815 MARKET ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2725
Mailing Address - Country:US
Mailing Address - Phone:409-770-6731
Mailing Address - Fax:409-770-6919
Practice Address - Street 1:815 MARKET ST
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-2725
Practice Address - Country:US
Practice Address - Phone:409-770-6731
Practice Address - Fax:409-770-6919
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1675208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA61988Medicare UPIN