Individual
ROBERT HEFFERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4212 NE BROADWAY ST, PORTLAND, OR 97213-1460
(503) 249-8787
Mailing address
4212 NE BROADWAY ST, PORTLAND, OR 97213-1460
(503) 249-8787
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD 10995
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23305-6
—
OR
Enumeration date
11/29/2006
Last updated
10/28/2010
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