Healthcare Provider Details

I. General information

NPI: 1891900023
Provider Name (Legal Business Name): DAVID J HECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 NW PROFESSIONAL DR
CORVALLIS OR
97330-3991
US

IV. Provider business mailing address

PO BOX 1014
CORVALLIS OR
97339-1014
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-8464
  • Fax:
Mailing address:
  • Phone: 541-757-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17190
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: