Provider Demographics
NPI:1083693618
Name:HEATON, JEFFERY P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:P
Last Name:HEATON
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 1:905 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-5049
Mailing Address - Country:US
Mailing Address - Phone:513-248-1210
Mailing Address - Fax:513-248-3065
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5049
Practice Address - Country:US
Practice Address - Phone:513-248-1210
Practice Address - Fax:513-248-3065
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-081468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2406382Medicaid