Provider Demographics
NPI:1134221658
Name:HEDGES, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HEDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:451 SEDGWICK SW
Mailing Address - Street 2:STE 220
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6425
Mailing Address - Country:US
Mailing Address - Phone:360-874-7300
Mailing Address - Fax:360-874-7319
Practice Address - Street 1:451 SEDGWICK SW
Practice Address - Street 2:STE 220
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6425
Practice Address - Country:US
Practice Address - Phone:360-874-7300
Practice Address - Fax:360-874-7319
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018787208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0264453OtherSTATE L&I
WA0264448OtherSTATE L&I
WA0264479OtherSTATE L&I
WA0291734OtherSTATE L&I
WAG000200181Medicare PIN
WA0264479OtherSTATE L&I
WAG8893877Medicare PIN