Provider Demographics
NPI:1003841180
Name:HEITHECKER, DONALD HENRY (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:HENRY
Last Name:HEITHECKER
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 1:135 MISSION RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-342-2411
Mailing Address - Fax:530-894-5783
Practice Address - Street 1:135 MISSION RANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-342-2411
Practice Address - Fax:530-894-5783
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11597207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G115970Medicaid
A38394Medicare UPIN
CA00G115970Medicaid