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Individual

HEATHER BETH LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
15970 SE MISTY DR STE 100, HAPPY VALLEY, OR 97086-4368
(503) 427-2637
(503) 659-8984
Mailing address
2160 NW 16TH AVE, PORTLAND, OR 97209-2564
(913) 219-0183

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD151090
OR
390200000X
Student in an Organized Health Care Education/Training Program
2007017298
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500624770
OR
Enumeration date
07/04/2007
Last updated
05/20/2020
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