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General NPI Number Information
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NPI Number | 1093791121
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Entity Type | Individual
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Provider Name | JOHN T. HEFFERNAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 502 S M ST
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City | TACOMA
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State | WA
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Zip | 98405-3728
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Country | US
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Telephone | 206-212-2100
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Fax | 206-212-2194
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Provider Business Mailing Address
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Address Line | 34719 6TH AVE S
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8714
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Country | US
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Telephone | 206-212-2100
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Fax | 206-212-2194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | MD00016843
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD00016843
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License Number State | WA
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