Provider Demographics
NPI:1043396104
Name:HEIL, JOHN RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RANDALL
Last Name:HEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32403-5612
Mailing Address - Country:US
Mailing Address - Phone:850-450-7849
Mailing Address - Fax:850-283-7021
Practice Address - Street 1:340 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32403-5612
Practice Address - Country:US
Practice Address - Phone:850-450-7849
Practice Address - Fax:850-283-7021
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1523052083X0100X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine