Healthcare Provider Details

I. General information

NPI: 1578612362
Provider Name (Legal Business Name): JOHN JOSEPH HERSCHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAPLE AVE
OAKLEY KS
67748-1220
US

IV. Provider business mailing address

212 MAPLE AVE
OAKLEY KS
67748-1220
US

V. Phone/Fax

Practice location:
  • Phone: 785-672-3261
  • Fax:
Mailing address:
  • Phone: 785-672-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-36281
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: