Healthcare Provider Details

I. General information

NPI: 1518975762
Provider Name (Legal Business Name): SCOTT K HEFLICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 SUMMITVIEW AVE SUITE 106
YAKIMA WA
98908-3027
US

IV. Provider business mailing address

732 SUMMITVIEW AVE #621
YAKIMA WA
98902-3032
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-6300
  • Fax: 509-454-6301
Mailing address:
  • Phone: 509-573-3448
  • Fax: 509-574-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00033146
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: