Basic Information
| Provider Information | |||||||||
| NPI: | 1114906443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERHES | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 S GARDEN WAY | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974018173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413452205 | ||||||||
| FaxNumber: | 5413454480 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 S GARDEN WAY | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974018173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413452205 | ||||||||
| FaxNumber: | 5413454480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD25082 | OR | Y | Allopathic & Osteopathic Physicians | Surgery | 174400000X | MD25082 | OR | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 275338 | 05 | OR | MEDICAID |