Herzog, Hazen Timothy

Herzog, Hazen Timothy is an individual health care provider with primary practice located at 1900 Woodland Dr , Coos Bay OR 97420-2045. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Herzog, Hazen Timothy can be contacted via phone (541) 267-5151.

Contact Information

Primary practice address
1900 Woodland Dr Coos Bay OR 97420-2045
Phone: (541) 267-5151
Fax: (541) 266-4501
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 7462373-1206 Utah
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA152638 Oregon

Profile Details

NPI number 1932433190
LBN Legal business name Herzog, Hazen Timothy
Credentials PHYSICIAN ASSISTANT
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2009
Last updated Nov 8th, 2013 - about 12 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 1932433190 NPPES
Oregon Other 161133 GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon MEDICAID 500625533 GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon Other 74623731206 GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon Other P01220506 GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon Other R000WFBTV GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon Other 1407812365 GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon Other 93-0635514 GROUP MEDICAID NORTH BEND MEDICAL CENTER
Oregon Other PA152638 GROUP MEDICAID NORTH BEND MEDICAL CENTER

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