Basic Information
| Provider Information | |||||||||
| NPI: | 1235349051 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EVAN H. HIRSCH, M.D., INC., P.S. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HIRSCH HOLISTIC FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 ENSIGN RD NE | ||||||||
| Address2: | SUITE N | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604649965 | ||||||||
| FaxNumber: | 8884068040 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 ENSIGN RD NE | ||||||||
| Address2: | SUITE N | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604649965 | ||||||||
| FaxNumber: | 8884068040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HIRSCH | ||||||||
| AuthorizedOfficialFirstName: | EVAN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3604649965 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | MD00046712 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.