Healthcare Provider Details

I. General information

NPI: 1568518728
Provider Name (Legal Business Name): LISA JILL HELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 NW CROSSING DR STE 102
BEND OR
97703-7049
US

IV. Provider business mailing address

400 NW FLAGLINE DR
BEND OR
97703-5570
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7741
  • Fax: 541-278-8375
Mailing address:
  • Phone: 541-306-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26780
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: