Provider Demographics
NPI:1265429088
Name:HEIN, JOHN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:HEIN
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:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MULLINS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3985
Practice Address - Country:US
Practice Address - Phone:541-451-7915
Practice Address - Fax:541-451-7943
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37906207Q00000X
ORMD22426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN134260514OtherUNITED HEALTH
TN4078723OtherBLUE CROSS BLUE SHIELD
TN3890462Medicaid
TN134260514OtherHUMANA
TN2638290OtherCIGNA
TN1846908OtherFIRST HEALTH
TN3890462Medicare ID - Type Unspecified
TN3890462Medicaid