Provider Demographics
NPI:1962942748
Name:JEFFREY G HEDGE DO PLLC
Entity type:Organization
Organization Name:JEFFREY G HEDGE DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:509-458-5889
Mailing Address - Street 1:906 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4538
Mailing Address - Country:US
Mailing Address - Phone:509-458-5889
Mailing Address - Fax:
Practice Address - Street 1:906 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4538
Practice Address - Country:US
Practice Address - Phone:509-458-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000013202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG319000179Medicare Oscar/Certification