# DR ALLEN J HERBERT A MEDICAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962629212
- **Authorized official:** DR. ALLEN J HERBERT MD (OWNER)
- **Authorized official phone:** (318) 255-7474

## Contact information

- **Practice address:** 411 E VAUGHN AVE, SUITE 203, RUSTON, LA 71270-5972
- **Practice address phone:** (318) 255-7474
- **Practice address fax:** (318) 254-5278
- **Mailing address:** PO BOX 1768, SHREVEPORT, LA 71166-1768
- **Mailing address phone:** (318) 677-7450
- **Mailing address fax:** (318) 425-5815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD010285 | LA | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 11/12/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1126403 | — | LA |