Individual
BRENT HEIMULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2435 NE CUMULUS AVE STE A, MCMINNVILLE, OR 97128-8862
(503) 472-6161
(503) 434-6290
Mailing address
2435 NE CUMULUS AVE STE A, MCMINNVILLE, OR 97128-8862
(503) 472-6161
(503) 434-6290
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD18814
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082284
—
OR
Enumeration date
05/18/2006
Last updated
01/09/2013
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