Healthcare Provider Details

I. General information

NPI: 1275522021
Provider Name (Legal Business Name): RICHARD NORMAN HENEGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAPITOL MALL DR SW SUITE 400
OLYMPIA WA
98502-8700
US

IV. Provider business mailing address

3920 CAPITOL MALL DR SW SUITE 400
OLYMPIA WA
98502-8700
US

V. Phone/Fax

Practice location:
  • Phone: 360-705-1259
  • Fax: 360-705-2757
Mailing address:
  • Phone: 360-705-1259
  • Fax: 360-705-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00029177
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: