Provider Demographics
NPI:1497741656
Name:HITZMAN, JONATHAN C (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:HITZMAN
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 1:1600 SE COURT PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3281
Mailing Address - Country:US
Mailing Address - Phone:541-276-1700
Mailing Address - Fax:541-276-6327
Practice Address - Street 1:1600 SE COURT PL
Practice Address - Street 2:SUITE 201
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3281
Practice Address - Country:US
Practice Address - Phone:541-276-1700
Practice Address - Fax:541-276-6327
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150643Medicaid
OR106816Medicare ID - Type UnspecifiedMEDICARE
OR150643Medicaid