Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD182141 | OR |
NPI | 1013278654 |
---|---|
Provider Name | Jared Hiebert |
First Address | Salem, OR 97302-9754 |
Second Address | Salem, OR 97302-9754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500722720 | (05) | OR |