Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD00029275 | WA |
N | 207N00000X | Dermatologist | MD17675 | WA |
NPI | 1003922279 |
---|---|
Provider Name | Craig Stephen Hersh |
First Address | Camas, WA 98607-9154 |
Second Address | Vancouver, WA 98686-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 04/02/2022 |