Provider Demographics
NPI:1922824531
Name:HEDGES, DEMI T (CHW)
Entity type:Individual
Prefix:MRS
First Name:DEMI
Middle Name:T
Last Name:HEDGES
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:MRS
Other - First Name:DEMARIE
Other - Middle Name:T
Other - Last Name:HEDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHW
Mailing Address - Street 1:16463 BOONES FERRY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4377
Mailing Address - Country:US
Mailing Address - Phone:503-635-3743
Mailing Address - Fax:503-635-1508
Practice Address - Street 1:16463 BOONES FERRY RD STE 400
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4377
Practice Address - Country:US
Practice Address - Phone:503-635-3743
Practice Address - Fax:503-635-1508
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1576402080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine