Provider Demographics
NPI:1235111329
Name:BEVAN, HEATHER JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JOY
Last Name:BEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 O ST
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5224
Mailing Address - Country:US
Mailing Address - Phone:916-442-1011
Mailing Address - Fax:916-444-8661
Practice Address - Street 1:2000 O ST
Practice Address - Street 2:SUITE 210A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5224
Practice Address - Country:US
Practice Address - Phone:916-442-1011
Practice Address - Fax:916-444-8661
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG663780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE91281Medicare UPIN
CA00G663780Medicare PIN