Provider Demographics
NPI:1487282125
Name:HERRERA, CHASE ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:ALEXANDER
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3314
Mailing Address - Country:US
Mailing Address - Phone:183-375-3235
Mailing Address - Fax:
Practice Address - Street 1:815 S PINE ST
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3353
Practice Address - Country:US
Practice Address - Phone:318-375-3239
Practice Address - Fax:318-375-2755
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA331859207P00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA331859OtherMEDICAL LICENSE NUMBER
LA2522817Medicaid