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General NPI Number Information
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NPI Number | 1427344563
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Entity Type | Individual
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Provider Name | KENNETH WEBSTER HEGEWALD D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 17355 LOWER BOONES FERRY RD STE 100A
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City | PORTLAND
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State | OR
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Zip | 97035
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Country | US
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Telephone | 503-224-8399
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Fax | 503-224-5661
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Provider Business Mailing Address
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Address Line | 17355 LOWER BOONES FERRY RD STE 100A
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City | PORTLAND
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State | OR
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Zip | 97035
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Country | US
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Telephone | 503-224-8399
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Fax | 503-224-5661
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PL60221075
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0808
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP177024
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License Number State | OR
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