Provider Demographics
NPI:1326184607
Name:HEIDINGER, WENDELL CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:CHARLES
Last Name:HEIDINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1094
Mailing Address - Country:US
Mailing Address - Phone:541-507-1948
Mailing Address - Fax:541-727-0382
Practice Address - Street 1:1600 NW 6TH ST
Practice Address - Street 2:SOUTH SUITE
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1094
Practice Address - Country:US
Practice Address - Phone:541-507-1948
Practice Address - Fax:541-727-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R145100Medicare PIN