| Doctor Name: | DR. MATTHEW EMIL HIESTERMAN |
| NPI Number: | 1154642387 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | PG151467 |
| Business Practice Address: | 560 Catalina Dr Ashland, OR - 975201605 |
| Business Phone Number: | 5412014800 |
| Business Fax Number: | 5412014801 |
| Mailing Address: | 2620 E Barnett Rd, Suite H MEDFORD |
| State: | OR |
| Postal Code: | 975048344 |
| Phone Number: | 5417894281 |
| Fax Number: | 5417892558 |
| NPI Enumeration Date: | 06/22/2010 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | PG151467 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |