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NPI Code Detail

MEDICARE: JOHN R HIEMSTRA D.O.

MEDICARE:   JOHN R HIEMSTRA  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOP00002028WA

General Provider Information

NPI Number : 1639102502
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R HIEMSTRA D.O.
Provider Business Mailing Address
First Line : 3610 MERIDIAN ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-1732
Country : US
Telephone Number : 360-318-8800
Fax Number :
Provider Business Practice Location Address
First Line : 1610 GROVER ST STE D1
Second Line :
City : LYNDEN
State : WA
Zip : 98264-1539
Country : US
Telephone Number : 360-354-1333
Fax Number : 360-354-5399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 04/27/2026

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