MEDICARE: FRED LUKE HERSCHER

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	207Q00000X	Family Medicine Physician	DO13700	OR

General Provider Information

NPI Number	:	1336339266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED LUKE HERSCHER

Provider Business Mailing Address
First Line	:	781 W CENTRAL AVE
Second Line	:
City	:	SUTHERLIN
State	:	OR
Zip	:	97479-9472
Country	:	US
Telephone Number	:	541-459-0303
Fax Number	:	541-459-1657

Provider Business Practice Location Address
First Line	:	781 W CENTRAL AVE
Second Line	:
City	:	SUTHERLIN
State	:	OR
Zip	:	97479-9472
Country	:	US
Telephone Number	:	541-459-0303
Fax Number	:	541-459-1657

Authorized Official
Title or Position	:	PHYSICAN
Name	:	DR. FRED LUKE HERSCHER
Credential	:	D.O.
Telephone Number	:	541-459-0303

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/28/2008

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