HAZEN TIMOTHY HERZOG (NPI# 1932433190) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932433190 |
| Entity Type | Individual |
| Full Name | HAZEN TIMOTHY HERZOG |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
1900 Woodland Dr Coos Bay OR 97420-2045 |
| Practice Telephone | 5412675151 |
| Practice Fax Number | 5412664501 |
| Mailing Telephone | 5412675151 |
| Mailing Fax Number | 5412664501 |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2013-11-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 7462373-1206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA152638 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | GROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER | 93-0635514 | 01 |
| OR | GROUP NPI NORTH BEND MEDICAL CENTER | 1407812365 | 01 |
| OR | 500625533 | 05 | |
| OR | GROUP MEDICARE NORTH BEND MEDICAL CENTER | R000WFBTV | 01 |
| UT | LICENSE | 74623731206 | 01 |
| OR | MEDICAL LICENSE | PA152638 | 01 |
| OR | RAILROAD MEDICARE | P01220506 | 01 |
| OR | GROUP MEDICAID NORTH BEND MEDICAL CENTER | 161133 | 01 |
| Street Address |
1900 WOODLAND DR |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-2045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174517528 | Mary Irene Hernandez | Physical Therapist | 1900 Woodland Dr, Coos Bay, OR 97420 | 2005-08-31 |
| 1477189009 | Sandy Lynn Teeter | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2020-03-16 |
| 1114564630 | Mitaliben Rajendrakumar Gor | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-12-03 |
| 1568014942 | Nikkona Henderson | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2019-07-15 |
| 1861050189 | James Murray | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-06-01 |
| 1346803640 | Sophia Elizabeth Massey | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-04-22 |
| 1750857090 | Alaina Therese Hendrix | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-10-14 |
| 1801382155 | Yulia Viktorovna Whidden | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-07-10 |
| 1124525043 | Samantha Decker | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-04-07 |
| 1043712383 | Gregory Sopka | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730618513 | Brent Daniel Hatch | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2017-06-06 |
| 1548705585 | Matthew E Cornia | Physician Assistant | 2699 N 17th St, Coos Bay, OR 97420-2134 | 2016-12-29 |
| 1952352395 | Herbert M Schaur | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619575008 | Janna Marie Check | Physician Assistant | 3555 Chad Drive, Eugene, OR 97408 | 2020-10-16 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1396250122 | Saron Theresa Sufuentes | Physician Assistant | 578 Nw Marlborough Ave, Portland, OR 97210-3104 | 2017-12-01 |
| 1801321039 | Devin Fleming | Physician Assistant | 22936 Ne Pike St, Troutdale, OR 97060-2615 | 2017-04-25 |
| 1710435011 | Alexander Andersen | Physician Assistant | 445 Harlow Rd Ste 200, Springfield, OR 97477-1341 | 2016-09-14 |
| 1952775520 | Lauren Govier | Physician Assistant | 501 N Graham St Ste 415, Portland, OR 97227-2006 | 2015-11-19 |
| 1619346368 | Ryan Mcmahon | Physician Assistant | 3415 Ne 20th Ave, Portland, OR 97212-2416 | 2015-09-23 |
| 1518366863 | Latoya Allen | Physician Assistant | 2450 Highgate St, Unit 12, Medford, OR 97501-7955 | 2014-08-21 |
| 1528499910 | Elan Kennedy | Physician Assistant | 3181 Sw Sam Jackson Park Rd., Mail Code L353, Ohsu, Division of Cardiothoracic Surgery, Portland, OR 97239 | 2013-12-10 |
| 1699114421 | Lauren M Kendall | Physician Assistant | 960 N 16th St Ste 108, Springfield, OR 97477-4175 | 2013-06-14 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on HAZEN TIMOTHY HERZOG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.