Individual
JOHN DAVID HEINTZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8573
Mailing address
1912 SE 43RD AVE, PORTLAND, OR 97215-3119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD25673
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213614
—
OR
Enumeration date
07/14/2006
Last updated
07/08/2007
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