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NPI Code Detail

MEDICARE: DR. CRAIG CHARLES HERTHER M.D.

MEDICARE: DR. CRAIG CHARLES HERTHER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician25217IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
142098297111OTHERIAJOHN DEERE PROVIDER ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548241037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG CHARLES HERTHER M.D.
Provider Business Mailing Address
First Line : 310 N GRANDVIEW AVE
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-6388
Country : US
Telephone Number : 563-588-0506
Fax Number : 563-588-0451
Provider Business Practice Location Address
First Line : 310 N GRANDVIEW AVE
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-6388
Country : US
Telephone Number : 563-588-0506
Fax Number : 563-588-0451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 09/24/2007

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