Provider Demographics
NPI:1194902502
Name:HIRTLE, SAMUEL ADEN (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ADEN
Last Name:HIRTLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-664-3346
Mailing Address - Fax:541-664-6051
Practice Address - Street 1:870 S FRONT ST
Practice Address - Street 2:STE 200
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2779
Practice Address - Country:US
Practice Address - Phone:541-664-3346
Practice Address - Fax:541-664-6051
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60409596207Q00000X
WAOL60286768207Q00000X
ORDO171203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine