MEDICARE: DR. JOHN C HEDGES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	MD00018787	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0264453	OTHER	WA	STATE L&I
2	0264448	OTHER	WA	STATE L&I
3	0264479	OTHER	WA	STATE L&I
4	0291734	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1134221658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C HEDGES MD

Provider Business Mailing Address
First Line	:	451 SEDGWICK SW
Second Line	:	STE 220
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-874-7300
Fax Number	:	360-874-7319

Provider Business Practice Location Address
First Line	:	451 SEDGWICK SW
Second Line	:	STE 220
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6425
Country	:	US
Telephone Number	:	360-874-7300
Fax Number	:	360-874-7319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	05/30/2012

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