Provider Demographics
NPI:1952385346
Name:HERRERA, JUAN MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MIGUEL
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 1:5959 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235
Mailing Address - Country:US
Mailing Address - Phone:214-879-8490
Mailing Address - Fax:214-879-8496
Practice Address - Street 1:5959 HARRY HINES BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-879-8490
Practice Address - Fax:214-879-8496
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035422701Medicaid
TX035422701Medicaid
00QC92Medicare ID - Type Unspecified