Provider Demographics
NPI:1194704445
Name:HAGGERTY, JEAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 NE 137TH AVENUE
Mailing Address - Street 2:KAISER PERMANANTE ORCHARDS MEDICAL OFFICE
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682
Mailing Address - Country:US
Mailing Address - Phone:503-813-3742
Mailing Address - Fax:877-821-5101
Practice Address - Street 1:7101 NE 137TH AVE OFC
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-4933
Practice Address - Country:US
Practice Address - Phone:503-813-3742
Practice Address - Fax:877-821-5101
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-234408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI20578Medicare UPIN