Provider Demographics
NPI:1538156179
Name:HEMSTREET, JEFFREY C (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:HEMSTREET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 MT HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071
Mailing Address - Country:US
Mailing Address - Phone:503-873-1500
Mailing Address - Fax:970-586-9096
Practice Address - Street 1:342 FAIRVIEW STREET
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381
Practice Address - Country:US
Practice Address - Phone:503-873-1500
Practice Address - Fax:970-586-9096
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD150733207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01360841Medicaid
COL5398Medicare ID - Type Unspecified
CO01360841Medicaid