Healthcare Provider Details

I. General information

NPI: 1174625131
Provider Name (Legal Business Name): JEFFREY J. HEFFERNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 COTTONWOOD ST
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

1325 COTTONWOOD ST
WOODLAND CA
95695-5131
US

V. Phone/Fax

Practice location:
  • Phone: 530-669-2800
  • Fax:
Mailing address:
  • Phone: 530-668-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35698
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: