Healthcare Provider Details

I. General information

NPI: 1407935521
Provider Name (Legal Business Name): JEFFREY G HEDGE D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 W 2ND AVE STE 600
SPOKANE WA
99201-4539
US

IV. Provider business mailing address

906 W 2ND AVE STE 600
SPOKANE WA
99201-4539
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-5889
  • Fax: 509-624-1216
Mailing address:
  • Phone: 509-458-5889
  • Fax: 509-624-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOP00001320
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: