MEDICARE: FRED LUKE HERSCHER DO

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	13700	OR

General Provider Information

NPI Number	:	1619974235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED LUKE HERSCHER DO

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	04/25/2023

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