Provider Demographics
NPI:1174555361
Name:HERRON, JAMES R (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4008 CHESTER DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1047
Mailing Address - Country:US
Mailing Address - Phone:312-291-9083
Mailing Address - Fax:312-624-9183
Practice Address - Street 1:1030 N CLARK ST
Practice Address - Street 2:STE 647
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5467
Practice Address - Country:US
Practice Address - Phone:312-291-9083
Practice Address - Fax:312-624-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036047483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047483Medicaid
IL036047483Medicaid
494260Medicare ID - Type Unspecified