Provider Demographics
NPI:1639102502
Name:HIEMSTRA, JOHN R (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HIEMSTRA
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Gender:M
Credentials:DO
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:1610 GROVER ST
Practice Address - Street 2:SUITE D-1
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:US
Practice Address - Phone:360-354-1333
Practice Address - Fax:360-354-5399
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-11-07
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Provider Licenses
StateLicense IDTaxonomies
WAOP00002028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3976HIOtherREGENCE BLUESHIELD
WAP00241348OtherRAILROAD MEDICARE
WA0199675OtherL&I REGULAR
WA8431520Medicaid
WA423898076OtherGROUP HEALTH COOPERATIVE
WA8906770OtherL&I CRIME VICTIM
WAP00241348OtherRAILROAD MEDICARE
WA8906770OtherL&I CRIME VICTIM