MEDICARE: JASON HEFFERNAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2006-0328	NM
2	208M00000X	Hospitalist Physician	MD60051097	WA
3	207Q00000X	Family Medicine Physician	MD60051097	WA

General Provider Information

NPI Number	:	1528107562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON HEFFERNAN MD

Provider Business Mailing Address
First Line	:	9106 W RUTTER PKWY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-9210
Country	:	US
Telephone Number	:	509-385-4339
Fax Number	:

Provider Business Practice Location Address
First Line	:	5633 N LIDGERWOOD
Second Line	:	HOLY FAMILY HOSPITAL
City	:	SPOKANE
State	:	WA
Zip	:	99208-0001
Country	:	US
Telephone Number	:	509-482-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/13/2018

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