Individual
DR. TIMOTHY E HERNDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4351 E LOHMAN AVE, SUITE 100, LAS CRUCES, NM 88011-8259
(575) 532-9077
(575) 532-9221
Mailing address
2661 S BEAR CLAW WAY, MERIDIAN, ID 83642-4468
(575) 496-1642
(301) 517-9067
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
82-210
NM
208D00000X
General Practice Physician
Primary
M-13463
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23209259
—
NM
Enumeration date
01/06/2006
Last updated
05/21/2021
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