Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD26460 | OR |
NPI | 1013090299 |
---|---|
Provider Name | John Edward Heffner |
First Address | Portland, OR 97213 |
Second Address | Portland, OR 97213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
242002 | (05) | OR |
B92673 | (02) |