Provider Demographics
NPI:1164468062
Name:HARGIS, JUDITH A (PA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:HARGIS
Suffix:
Gender:F
Credentials:PA
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 4949
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4949
Mailing Address - Country:US
Mailing Address - Phone:503-215-6446
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:3911 CASTLEVALE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-453-8231
Practice Address - Fax:509-453-0130
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436271Medicaid
WA8436271Medicaid
WAG8800048Medicare PIN