Basic Information
| Provider Information | |||||||||
| NPI: | 1134139595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERR | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1608 S J ST FL 5 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534266731 | ||||||||
| FaxNumber: | 2533828174 | ||||||||
| Practice Location | |||||||||
| Address1: | 1608 S J ST FL 5 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534266731 | ||||||||
| FaxNumber: | 2533828174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | MD60909611 | WA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207Y00000X | MD60909611 | WA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1134139595 | 05 | WA | MEDICAID | 2120946 | 05 | WA | MEDICAID |