Healthcare Provider Details

I. General information

NPI: 1013286822
Provider Name (Legal Business Name): LAWRENCE THOMAS ESCHELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 CHEROKEE DR S
SALEM OR
97302-9712
US

IV. Provider business mailing address

3585 CHEROKEE DR S
SALEM OR
97302-9712
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-0710
  • Fax: 503-763-1591
Mailing address:
  • Phone: 503-399-0710
  • Fax: 503-763-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD07035
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: