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General NPI Number Information
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NPI Number | 1407140700
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Entity Type | Organization
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Legal Business Name | WENDELL C HEIDINGER MD
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 2301 CLAIRMONT DRIVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97601
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Country | US
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Telephone | 541-850-7697
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 CLAIRMONT DRIVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97601
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Country | US
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Telephone | 541-850-7697
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WENDELL C HEIDINGER
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Credential | M.D.
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Telephone | 541-850-7697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD18680
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License Number State | OR
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