Individual
DR. ALLEN J HERBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
411 E VAUGHN AVE, SUITE 203, RUSTON, LA 71270-5972
(318) 255-7474
(318) 425-2335
Mailing address
PO BOX 1768, SHREVEPORT, LA 71166-1768
(318) 677-7450
(318) 425-5815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD 010285
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1126403
—
LA
01
—
720972556
TRICARE
LA
Enumeration date
05/31/2006
Last updated
11/12/2009
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