Basic Information
| Provider Information | |||||||||
| NPI: | 1710203955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERFORD | ||||||||
| FirstName: | BARON | ||||||||
| MiddleName: | VANCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 ALCORN DR | ||||||||
| Address2: | SUITE 2C | ||||||||
| City: | CORINTH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388349072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622869255 | ||||||||
| FaxNumber: | 6622869274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385014294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313722770 | ||||||||
| FaxNumber: | 9315251176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20998 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2847 | TN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P00951695 | 01 | MS | RAILROAD MEDICARE | OTHER | 302I116832 | 01 | MS | MEDICARE | OTHER | 05005793 | 05 | MS | MEDICAID |