Healthcare Provider Details

I. General information

NPI: 1528107562
Provider Name (Legal Business Name): JASON HEFFERNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD HOLY FAMILY HOSPITAL
SPOKANE WA
99208-0001
US

IV. Provider business mailing address

9106 W RUTTER PKWY
SPOKANE WA
99208-9210
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-0111
  • Fax:
Mailing address:
  • Phone: 509-385-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006-0328
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60051097
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60051097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: