Healthcare Provider Details

I. General information

NPI: 1730169251
Provider Name (Legal Business Name): SCOTT T HEGSTAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 BROADWAY ST
ALEXANDRIA MN
56308-2537
US

IV. Provider business mailing address

1527 BROADWAY ST
ALEXANDRIA MN
56308-2537
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-0399
  • Fax: 320-762-6847
Mailing address:
  • Phone: 320-762-0399
  • Fax: 320-762-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39789
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39789
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: