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General NPI Number Information
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NPI Number | 1154642387
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Entity Type | Individual
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Provider Name | MATTHEW EMIL HIESTERMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 560 CATALINA DR
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City | ASHLAND
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State | OR
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Zip | 97520-1605
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Country | US
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Telephone | 541-201-4800
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Fax | 541-201-4801
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Provider Business Mailing Address
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Address Line | 2620 E BARNETT RD SUITE H
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City | MEDFORD
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State | OR
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Zip | 97504-8344
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Country | US
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Telephone | 541-789-4281
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Fax | 541-789-2558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | PG151467
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DO172346
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License Number State | OR
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