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General NPI Number Information
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NPI Number | 1568287688
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Entity Type | Organization
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Legal Business Name | GOLDMARK WOUND SPECIALTY GROUP MPO, LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 7150 SW HAMPTON ST STE 101
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City | TIGARD
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State | OR
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Zip | 97223-8365
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Country | US
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Telephone | 971-236-4445
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Fax | 971-236-4445
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Provider Business Mailing Address
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Address Line | 7150 SW HAMPTON ST STE 101
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City | TIGARD
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State | OR
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Zip | 97223-8365
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Country | US
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Telephone | 971-236-4445
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Fax | 971-236-4445
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | DR. HEIDI HAGMAN
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Credential | MD
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Telephone | 971-910-3888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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