Provider Demographics
NPI:1962603175
Name:HIRSELJ, DANIEL AARON (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:AARON
Last Name:HIRSELJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NE GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3001
Mailing Address - Country:US
Mailing Address - Phone:503-284-4018
Mailing Address - Fax:
Practice Address - Street 1:2230 NW PETTYGROVE ST
Practice Address - Street 2:SUITE #210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-223-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0897302088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology