Basic Information
| Provider Information | |||||||||
| NPI: | 1164629515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERPICH | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | KENDALL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018152869 | ||||||||
| FaxNumber: | 6018159356 | ||||||||
| Practice Location | |||||||||
| Address1: | 5200 FAIRVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550928013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519827000 | ||||||||
| FaxNumber: | 6519827110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TRN11509 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 21044 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME105030 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036158477 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD.204283 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8940397 | 05 | MS | MEDICAID | 01276718 | 05 | MS | MEDICAID |