Individual
TYLER L HEIDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2435 NE CUMULUS AVE, MCMINNVILLE, OR 97128-8805
(503) 472-6161
(503) 434-6290
Mailing address
2435 NE CUMULUS AVE, MCMINNVILLE, OR 97128-8805
(503) 472-6161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/30/2022
Last updated
10/03/2022
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