MEDICARE: DR. JOSEPH L. HERSON III DO

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	34-3347	OH

General Provider Information

NPI Number	:	1831241835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH L. HERSON III DO

Provider Business Mailing Address
First Line	:	1275 OLENTANGY RIVER RD
Second Line	:	ST.110
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3119
Country	:	US
Telephone Number	:	614-294-1888
Fax Number	:	614-294-7663

Provider Business Practice Location Address
First Line	:	1275 OLENTANGY RIVER RD
Second Line	:	ST.110
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3119
Country	:	US
Telephone Number	:	614-294-1888
Fax Number	:	614-294-7663

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	12/19/2007

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