Individual
HOMER HERLONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390
(614) 648-6936
Mailing address
PO BOX 845347, DALLAS, TX 75284-7208
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
40471
SC
207RG0100X
Gastroenterology Physician
D23650
MD
207RG0100X
Gastroenterology Physician
Primary
P4764
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324869201 (MDACC)
—
TX
05
—
404716
—
SC
01
—
8DN730
BCBS (MDACC)
TX
05
—
988751200
—
MD
01
—
P01230052
RR MEDICARE (MDACC)
TX
Enumeration date
05/11/2006
Last updated
05/20/2019
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