Basic Information
| Provider Information | |||||||||
| NPI: | 1912994526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | XAVIER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 E PROSPECT RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805255304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704957410 | ||||||||
| FaxNumber: | 9704957425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 E PROSPECT RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805255304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704957410 | ||||||||
| FaxNumber: | 9704957425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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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 | 207RG0300X | DR.0047282 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | DR.0047282 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 09856315 | 05 | CO | MEDICAID |