Organization
DAVID HEREDIA MD. PA.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID LUIS HEREDIA M.D. (PRESIDENT)
(361) 229-9116
Entity
Organization
Contact information
Practice address
1500 WILDCAT DR, SUITE H, PORTLAND, TX 78374-2825
(361) 777-3330
(361) 777-2811
Mailing address
1500 WILDCAT DR, SUITE H, PORTLAND, TX 78374-2825
(361) 777-3330
(361) 777-2811
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L8073
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196700201
—
TX
Enumeration date
05/07/2008
Last updated
03/28/2023
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