Provider Demographics
NPI:1548241037
Name:HERTHER, CRAIG CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CHARLES
Last Name:HERTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6388
Mailing Address - Country:US
Mailing Address - Phone:563-588-0506
Mailing Address - Fax:563-588-0451
Practice Address - Street 1:310 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-588-0506
Practice Address - Fax:563-588-0451
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25217207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42098297111OtherJOHN DEERE PROVIDER ID
IA0034587Medicaid
IAA02909Medicare UPIN
IA0034587Medicaid