Provider Demographics
NPI:1669478343
Name:HEINONEN, LARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:HEINONEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:975 SE SANDY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1308
Mailing Address - Country:US
Mailing Address - Phone:503-236-0775
Mailing Address - Fax:503-236-0786
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6689
Practice Address - Country:US
Practice Address - Phone:503-297-8081
Practice Address - Fax:503-292-6601
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD09495207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8502635Medicaid
OR042499Medicaid
WA8502635Medicaid
OR042499Medicaid