MEDICARE: MELVIN HERD

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
1	207Q00000X	Family Medicine Physician	MD2757	OR

General Provider Information

NPI Number	:	1568443794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN HERD

Provider Business Mailing Address
First Line	:	4105 DUANE DR S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-6127
Country	:	US
Telephone Number	:	503-585-2669
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 SE NORTON LN STE A
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8484
Country	:	US
Telephone Number	:	503-472-9002
Fax Number	:	503-474-0157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	10/16/2019

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Directions to “ MELVIN HERD ” Practice Location

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