MEDICARE: DR. LAWRENCE THOMAS ESCHELMAN M.D.

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	207Y00000X	Otolaryngology Physician	MD07035	OR

General Provider Information

NPI Number	:	1013286822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE THOMAS ESCHELMAN M.D.

Provider Business Mailing Address
First Line	:	3585 CHEROKEE DR S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9712
Country	:	US
Telephone Number	:	503-399-0710
Fax Number	:	503-763-1591

Provider Business Practice Location Address
First Line	:	3585 CHEROKEE DR S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9712
Country	:	US
Telephone Number	:	503-399-0710
Fax Number	:	503-763-1591

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

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/22/2011

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