Provider Demographics
NPI:1447449368
Name:HEITSCH, RICHARD CARLTON (MD, MPH, FACS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARLTON
Last Name:HEITSCH
Suffix:
Gender:M
Credentials:MD, MPH, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:163 NE 102ND AVE
Mailing Address - Street 2:BUILDING V
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4169
Mailing Address - Country:US
Mailing Address - Phone:503-257-3327
Mailing Address - Fax:503-257-3374
Practice Address - Street 1:163 NE 102ND AVE
Practice Address - Street 2:BUILDING V
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4169
Practice Address - Country:US
Practice Address - Phone:503-257-3327
Practice Address - Fax:503-257-3374
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11610208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00078868OtherMEDICARE RAILROAD
ORR117635Medicare PIN