Provider Demographics
NPI:1063773752
Name:HIEBERT, RACHAEL (MD)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HIEBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2546
Mailing Address - Country:US
Mailing Address - Phone:503-362-2481
Mailing Address - Fax:503-375-8700
Practice Address - Street 1:2478 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2546
Practice Address - Country:US
Practice Address - Phone:503-362-2481
Practice Address - Fax:503-375-8700
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29315208000000X
ORMD182140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500723597Medicaid