Individual
JOHN T. HEFFERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
502 S M ST, TACOMA, WA 98405-3728
(206) 212-2100
(206) 212-2194
Mailing address
34719 6TH AVE S, FEDERAL WAY, WA 98003-8714
(206) 212-2100
(206) 212-2194
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD00016843
WA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
MD00016843
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036104
LABOR & INDUSTRIES
WA
05
—
1777200
—
WA
01
—
180016727
RAILROAD MEDICARE
—
01
—
3862HE
REGENCE HEALTHCARE
—
Enumeration date
12/20/2005
Last updated
01/03/2024
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