HAZEN T HERZOG, PHYSICIAN ASSISTANT, Surgical COOS BAY, OR

Contact Information

HAZEN T HERZOG, PHYSICIAN ASSISTANT

1900 WOODLAND DR
COOS BAY, OR 97420-2045

Phone: 541-267-5151
Fax: 541-266-4501
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Surgical	363AS0400X	97	Physician Assistant
Physician Assistant	363A00000X	97	Physician Assistant

Indicates primary specialty

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NPI Profile & details for HAZEN T HERZOG · (Male)

NPI Number	`1932433190`
Status	Active
Credentials	PHYSICIAN ASSISTANT
Entity	Individual
Enumeration date	09/21/2009
Last updated	11/08/2013 - About 13 years ago
Sole proprietor ¹	No
Identifiers	OR License # PA152638 UT License # 7462373-1206 OR Medicaid 500625533 OR Other 161133 GROUP MEDICAID NORTH BEND MEDICAL CENTER OR Other R000WFBTV GROUP MEDICARE NORTH BEND MEDICAL CENTER OR Other 1407812365 GROUP NPI NORTH BEND MEDICAL CENTER OR Other 93-0635514 GROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER OR Other PA152638 MEDICAL LICENSE OR Other P01220506 RAILROAD MEDICARE UT Other 74623731206 LICENSE
Hospital affiliation(s)	ST LUKES MAGIC VALLEY RMC - (Acute Care) 801 POLE LINE ROAD WEST TWIN FALLS, ID 83301 ST LUKES REGIONAL MEDICAL CENTER - (Acute Care) 190 EAST BANNOCK STREET BOISE, ID 83712

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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HAZEN T HERZOG, PHYSICIAN ASSISTANT – NPI #1932433190Surgical

Contact Information

Specialty

Surgical

Physician Assistant

NPI Profile & details for HAZEN T HERZOG · (Male)

Reviews for HAZEN T HERZOG

HAZEN T HERZOG, PHYSICIAN ASSISTANT – NPI #1932433190
Surgical