Individual provider Active NPI

Henry G Herrod, MD

  • Pediatric Allergy/Immunology Physician
  • Memphis, TN
National Provider Identifier
1639135361
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Allergy/Immunology PhysicianTaxonomy code 2080P0201X
License
11337 Issued in TN
Practice address
1910 Nonconnah Blvd
Suite 120
Memphis, TN 38132-2113
Phone
(901) 448-2300
Fax
(901) 448-6657
NPI assigned
Apr 21, 2006
Last updated
Nov 27, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Allergy/Immunology Physician 2080P0201X 11337 TN Primary

Addresses

Primary practice location

1910 Nonconnah Blvd
Suite 120
Memphis, TN 38132-2113

Mailing address

66 N Pauline St
Suite 206
Memphis, TN 38105-5105
Phone (901) 448-7642

Other identifiers 1

IdentifierTypeStateIssuer
3177332MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1639135361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 N PAULINE ST",
            "address_2": "SUITE 206",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381055105",
            "telephone_number": "901-448-7642",
            "fax_number": "901-448-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 NONCONNAH BLVD",
            "address_2": "SUITE 120",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381322113",
            "telephone_number": "901-448-2300",
            "fax_number": "901-448-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERROD",
        "first_name": "HENRY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "TN",
            "license": "11337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3177332",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.