Healthcare Provider Details

I. General information

NPI: 1548241037
Provider Name (Legal Business Name): CRAIG CHARLES HERTHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

IV. Provider business mailing address

310 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-0506
  • Fax: 563-588-0451
Mailing address:
  • Phone: 563-588-0506
  • Fax: 563-588-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25217
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: