Provider Demographics
NPI:1831241835
Name:HERSON, JOSEPH L III (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:HERSON
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:1275 OLENTANGY RIVER RD
Mailing Address - Street 2:ST.110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3119
Mailing Address - Country:US
Mailing Address - Phone:614-294-1888
Mailing Address - Fax:614-294-7663
Practice Address - Street 1:1275 OLENTANGY RIVER RD
Practice Address - Street 2:ST.110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3119
Practice Address - Country:US
Practice Address - Phone:614-294-1888
Practice Address - Fax:614-294-7663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-12-19
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Provider Licenses
StateLicense IDTaxonomies
OH34-3347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA15125Medicare UPIN
OHHE0513566Medicare PIN