Provider Demographics
NPI:1962489575
Name:HAGMAN, HEIDI M (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
Last Name:HAGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:STE 230
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6629
Mailing Address - Country:US
Mailing Address - Phone:503-445-3235
Mailing Address - Fax:503-790-2293
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 238
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6629
Practice Address - Country:US
Practice Address - Phone:503-223-7214
Practice Address - Fax:503-227-7572
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD18350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00372707OtherRAILROAD MEDICARE/PALMETT
OR278722Medicaid
OR003335020OtherREGENCE BLUE CROSS
OR135805Medicare ID - Type Unspecified
OR278722Medicaid