Provider Demographics
NPI:1548323348
Name:DEHERRERA, ORLANDO R (DO)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:R
Last Name:DEHERRERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHICO CT
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1065
Mailing Address - Country:US
Mailing Address - Phone:719-852-9400
Mailing Address - Fax:719-852-9311
Practice Address - Street 1:103 CHICO CT
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1065
Practice Address - Country:US
Practice Address - Phone:719-852-9400
Practice Address - Fax:719-852-9311
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL1830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U8523OtherBCBS
TXP00200133OtherRAILROAD PROVIDER NUMBER
TX8K5235OtherPROVIDER BCBS NUMBER
TXP00200133OtherRAILROAD PROVIDER NUMBER
TX8U8523OtherBCBS