Healthcare Provider Details

I. General information

NPI: 1417068867
Provider Name (Legal Business Name): HEIFETZ & PALMER, MD'S, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 DONNER PASS RD SUITE 210
TRUCKEE CA
96161-4861
US

IV. Provider business mailing address

PO BOX 26525 SECTION #3051
OKLAHOMA CITY OK
73126-0525
US

V. Phone/Fax

Practice location:
  • Phone: 530-582-6450
  • Fax: 530-550-8169
Mailing address:
  • Phone: 918-806-1024
  • Fax: 918-286-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE J HEIFETZ
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 530-582-6450