| Name: | Mark D. Herron, M.D., L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Mar 2005 (20 years ago) (Companies founded in March 2005) |
| Entity Number: | 000-462-507 |
| Register Number: | 000462507 |
| ZIP code: | 36117 (Companies in Montgomery, 36117) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 300 TAYLOR RD STE 700MONTGOMERY, AL 36117 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104897073 | 2006-01-30 | 2010-04-14 | 7260 HALCYON SUMMIT DR, MONTGOMERY, AL, 361177047, US | 7260 HALCYON SUMMIT DR, MONTGOMERY, AL, 361177047, US | |||||||||||||||||||||||||
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| Phone | +1 334-277-3332 |
| Fax | 3342773522 |
Authorized person
| Name | MEREDITH DAFFIN |
| Role | ADMINISTRATOR |
| Phone | 3342727273 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | 21157 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529923240 |
| State | AL |
| Name | Role |
|---|---|
| HERRON, MARK D | Member |
| Name | Role |
|---|---|
| HERRON, MARK D | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
