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General NPI Number Information
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NPI Number | 1922194695
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Entity Type | Individual
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Provider Name | RICHARD DANIEL HEYERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 1698 E MCANDREWS RD SUITE 300
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City | MEDFORD
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State | OR
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Zip | 97504-5589
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Country | US
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Telephone | 541-732-7950
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Fax | 541-732-7901
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone | 541-732-7950
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Fax | 541-732-7901
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD13620
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License Number State | OR
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