Provider Demographics
NPI:1407809270
Name:HADLEY, SAMUEL JOSEPH (CSA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:HADLEY
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22834 SW FOREST CREEK DR
Mailing Address - Street 2:APT #202
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9874
Mailing Address - Country:US
Mailing Address - Phone:714-866-6955
Mailing Address - Fax:
Practice Address - Street 1:22834 SW FOREST CREEK DR
Practice Address - Street 2:APT #202
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9874
Practice Address - Country:US
Practice Address - Phone:714-866-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical