Individual
MISTY DAWN HEROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1720 S BECKHAM AVE STE 104, TYLER, TX 75701-4464
(903) 597-2002
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M7262
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75-2616977-136
TRICARE
TX
01
—
8FM252
BCBS
TX
Enumeration date
05/01/2009
Last updated
07/21/2022
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