Provider Demographics
NPI:1063570463
Name:HEDGES, PATRICIA A (RD)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:HEDGES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 HATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9409
Mailing Address - Country:US
Mailing Address - Phone:541-672-8533
Mailing Address - Fax:541-677-5574
Practice Address - Street 1:2371 NE STEPHENS ST STE 200
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1399
Practice Address - Country:US
Practice Address - Phone:541-672-8533
Practice Address - Fax:541-677-5574
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR885001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165772Medicaid