Healthcare Provider Details

I. General information

NPI: 1194704445
Provider Name (Legal Business Name): JEAN MARIE HAGGERTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NE 137TH AVE OFC
VANCOUVER WA
98682-4933
US

IV. Provider business mailing address

7101 NE 137TH AVENUE KAISER PERMANANTE ORCHARDS MEDICAL OFFICE
VANCOUVER WA
98682
US

V. Phone/Fax

Practice location:
  • Phone: 503-813-3742
  • Fax: 877-821-5101
Mailing address:
  • Phone: 503-813-3742
  • Fax: 877-821-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101-234408
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: