Individual
EDWIN W HERRON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-1565
(318) 675-6681
Mailing address
1541 KINGS HWY, ATTN: PAYOR CREDENTIALING, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
19165
MS
207L00000X
Anesthesiology Physician
Primary
MD.09254R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09821501
—
MS
05
—
1539694
—
LA
Enumeration date
09/28/2006
Last updated
01/13/2025
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