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General NPI Number Information
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NPI Number | 1013302348
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Entity Type | Individual
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Provider Name | JONATHAN HATTENHAUER D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 10150 SE 32ND AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-6516
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Country | US
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Telephone | 503-215-5895
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4180
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City | PASADENA
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State | CA
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Zip | 91110-4180
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Country | US
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Telephone | 503-215-6494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | OP61629049
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | DO203654
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License Number State | OR
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