Hagen, Kerry Brent

Hagen, Kerry Brent is an individual health care provider with primary practice located at 1955 Nw Northrup St , Portland OR 97209-1614. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Hagen, Kerry Brent can be contacted via phone (503) 227-2020.

Contact Information

Primary practice address
1955 Nw Northrup St Portland OR 97209-1614
Phone: (503) 227-2020
Fax: (503) 222-0614
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD18505 Oregon

Profile Details

NPI number 1295717379
LBN Legal business name Hagen, Kerry Brent
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2005
Last updated Nov 17th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295717379 NPPES
Oregon MEDICAID 121033

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