Healthcare Provider Details

I. General information

NPI: 1669440400
Provider Name (Legal Business Name): ANNA CAROLYN HEJINIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/30/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 EAST 13TH AVENUE
EUGENE OR
97403-1232
US

IV. Provider business mailing address

1232 UNIVERSITY OF OREGON
EUGENE OR
97403-1205
US

V. Phone/Fax

Practice location:
  • Phone: 541-747-4300
  • Fax: 541-747-0655
Mailing address:
  • Phone: 541-346-2770
  • Fax: 844-965-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24977
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier275290
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: