Provider Demographics
NPI:1720066749
Name:HERRERA, MARCOS A (MD)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:A
Last Name:HERRERA
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 1:6010 MCPHERSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6208
Mailing Address - Country:US
Mailing Address - Phone:956-727-2362
Mailing Address - Fax:956-727-2363
Practice Address - Street 1:6010 MCPHERSON RD STE 200
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6208
Practice Address - Country:US
Practice Address - Phone:956-727-2362
Practice Address - Fax:956-727-2363
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH55652085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105554OtherUCARE
MN39B27HEOtherBCBS
MN913307100Medicaid
MN1601188OtherMEDICA
MN785173OtherAMERICAS PPO
MNNA2951017151OtherPREFERRED ONE
MNHP10598OtherHEALTH PARTNERS
300106175OtherRR MEDICARE
410849339 56001 C115OtherCHAMPUS
MN1601188OtherMEDICA
MN300001875Medicare ID - Type Unspecified
MN913307100Medicaid