Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Hazen Timothy Herzog, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1932433190

Hazen Timothy Herzog, PHYSICIANASSISTANT is a Physician Assistant in Coos Bay, Oregon. Qualified in 2009, 17 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon and Utah.

Years since qualifying
17
Licensed in
OR, UT
In the registry since
2009
Specialties on file
2
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Practice location Address checks out

1900 Woodland Dr
Coos Bay, OR 97420-2045
Phone: (541) 267-5151
Fax: (541) 266-4501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA152638 (OR)
Physician Assistant Taxonomy 363A00000X · Licence 7462373-1206 (UT)

Record details

NPI number1932433190
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedSeptember 21, 2009
Last updated in NPPESNovember 8, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations8 on file with Medicare

Other providers in Coos Bay