Healthcare Provider Details

I. General information

NPI: 1427344563
Provider Name (Legal Business Name): KENNETH WEBSTER HEGEWALD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 08/22/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17355 LOWER BOONES FERRY RD STE 100A
PORTLAND OR
97035
US

IV. Provider business mailing address

17355 LOWER BOONES FERRY RD STE 100A
PORTLAND OR
97035
US

V. Phone/Fax

Practice location:
  • Phone: 503-224-8399
  • Fax: 503-224-5661
Mailing address:
  • Phone: 503-224-8399
  • Fax: 503-224-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPL60221075
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0808
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP177024
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: