Provider Demographics
NPI:1093907859
Name:GAMMON, HEATHER P (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:P
Last Name:GAMMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARSHA
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:763-587-4200
Mailing Address - Fax:763-587-4205
Practice Address - Street 1:601 JACOB LN
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1776
Practice Address - Country:US
Practice Address - Phone:763-587-4200
Practice Address - Fax:763-587-4205
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20166207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology