Provider Demographics
NPI:1881692630
Name:HEDGES, ALLAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JOHN
Last Name:HEDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALLAN
Other - Middle Name:
Other - Last Name:HEDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 SE NORTON LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8479
Mailing Address - Country:US
Mailing Address - Phone:503-434-6688
Mailing Address - Fax:503-472-6531
Practice Address - Street 1:235 SE NORTON LN
Practice Address - Street 2:SUITE B
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8479
Practice Address - Country:US
Practice Address - Phone:503-434-6688
Practice Address - Fax:503-472-6531
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25530207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028437Medicaid
OR028437Medicaid
G11116Medicare UPIN