Provider Demographics
NPI:1396701504
Name:HADDEN, ANTHONY G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:HADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:G
Other - Last Name:HADDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2275 NE DOCTORS DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-585-2400
Mailing Address - Fax:541-585-2407
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-858-2400
Practice Address - Fax:541-585-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00A742770Medicare ID - Type Unspecified