Individual
DR. MICHAEL P HEFFERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 SANTA ROSA ST, SAN LUIS OBISPO, CA 93405-1811
(805) 541-2650
(805) 541-4043
Mailing address
15 SANTA ROSA ST, SAN LUIS OBISPO, CA 93405-1811
(805) 541-2650
(805) 541-4043
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01072447A
IN
207N00000X
Dermatology Physician
35074557
OH
207N00000X
Dermatology Physician
Primary
G80065
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201183400
—
IN
05
—
2601929
—
OH
Enumeration date
04/21/2006
Last updated
10/13/2014
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