Provider Demographics
NPI:1043207509
Name:HASSRICK, PHILLIP H (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:H
Last Name:HASSRICK
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:19200 NORTH KELSEY STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1162
Practice Address - Country:US
Practice Address - Phone:425-805-4790
Practice Address - Fax:425-805-4791
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60467699207Q00000X
UT268705-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005193041Medicare PIN
WAG8932553Medicare UPIN
UTF67200Medicare UPIN