Provider Demographics
NPI:1881678167
Name:HEGEDUS, STEPHEN I (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:I
Last Name:HEGEDUS
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 1:750 E LATHAM AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4370
Mailing Address - Country:US
Mailing Address - Phone:951-658-2271
Mailing Address - Fax:951-766-7653
Practice Address - Street 1:750 E LATHAM AVE
Practice Address - Street 2:STE 3
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4370
Practice Address - Country:US
Practice Address - Phone:951-658-2271
Practice Address - Fax:951-766-7653
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC33512207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00244114OtherMEDICARE RAILROAD
CA00C335120Medicaid
CA00C335120OtherBLUE CROSS BLUE SHIELD
CA00C335120Medicaid
CAP00244114OtherMEDICARE RAILROAD