Provider Demographics
NPI:1518975762
Name:HEFLICK, SCOTT K (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:HEFLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:732 SUMMITVIEW AVE
Mailing Address - Street 2:#621
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3032
Mailing Address - Country:US
Mailing Address - Phone:509-573-3448
Mailing Address - Fax:509-574-4481
Practice Address - Street 1:6201 SUMMITVIEW AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3027
Practice Address - Country:US
Practice Address - Phone:509-454-6300
Practice Address - Fax:509-454-6301
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00033146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8191710Medicaid
G8800382Medicare PIN
G26464Medicare UPIN