Healthcare Provider Details

I. General information

NPI: 1245406008
Provider Name (Legal Business Name): HEIDI A ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI A WELTER

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE NEFF RD
BEND OR
97701-6337
US

IV. Provider business mailing address

PO BOX 7287
BEND OR
97708-7287
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4800
  • Fax: 541-706-4806
Mailing address:
  • Phone: 541-447-6263
  • Fax: 541-447-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD152893
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: