Organization Name: | MICHAEL T. HEGSTROM,MD, PLLC |
NPI Number: | 1942359401 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL TERRANCE HEGSTROM (PHYSICIAN) |
Mailing Address: | 510 Cherry Street Suite 206, Blgd. A Bluefield |
State: | WV US |
Postal Code: | 247013341 |
Phone Number: | 3043271888 |
Fax Number: | 3043271889 |
NPI Enumeration Date: | 01/10/2007 |
NPI Last Update Date: | 08/09/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 21695 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |