Provider Demographics
NPI:1184631764
Name:HEITMAN, WILLIAM HARRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRY
Last Name:HEITMAN
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 1:2401 FRIST BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4839
Mailing Address - Country:US
Mailing Address - Phone:772-465-8100
Mailing Address - Fax:772-465-8615
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-465-8100
Practice Address - Fax:772-465-8615
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME070883208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)