Provider Demographics
NPI:1346401742
Name:MERLO-GRIFANTINI, HEATHER CALLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CALLEEN
Last Name:MERLO-GRIFANTINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E MAIN ST
Mailing Address - Street 2:P.O. BOX 1020
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9674
Mailing Address - Country:US
Mailing Address - Phone:541-582-0505
Mailing Address - Fax:
Practice Address - Street 1:509 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9674
Practice Address - Country:US
Practice Address - Phone:541-582-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine