Provider Demographics
NPI:1720079593
Name:HERRIN, JAMES R (PAC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:HERRIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98035
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-9035
Mailing Address - Country:US
Mailing Address - Phone:225-766-0050
Mailing Address - Fax:225-766-1499
Practice Address - Street 1:17199 SPRING RANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-2900
Practice Address - Country:US
Practice Address - Phone:225-686-4900
Practice Address - Fax:225-686-4901
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1315443Medicaid
5A274P371Medicare ID - Type Unspecified