Provider Demographics
NPI:1851387849
Name:HERO, TONI LORAINE (DO)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LORAINE
Last Name:HERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NE ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7464
Mailing Address - Country:US
Mailing Address - Phone:503-665-9144
Mailing Address - Fax:503-665-6404
Practice Address - Street 1:400 NE ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7464
Practice Address - Country:US
Practice Address - Phone:503-665-9144
Practice Address - Fax:503-665-6404
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079546Medicaid
OR118823Medicare ID - Type Unspecified
OR079546Medicaid