Provider Demographics
NPI:1689690448
Name:HERRON, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:HERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4700 POINT FOSDICK DR NW
Mailing Address - Street 2:SUITE 319
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-853-3888
Mailing Address - Fax:253-853-7393
Practice Address - Street 1:4700 POINT FOSDICK DR NW
Practice Address - Street 2:SUITE 319
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-853-3888
Practice Address - Fax:253-853-7393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1017995Medicaid
A08865Medicare UPIN