Provider Demographics
NPI:1932632767
Name:HERRING, KYLE B (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:B
Last Name:HERRING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:550 DURBIN PAVILION DR STE G101
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4135
Practice Address - Country:US
Practice Address - Phone:904-770-2095
Practice Address - Fax:904-390-7425
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS16618207Q00000X
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine