Provider Demographics
NPI:1306014626
Name:HEFFINGTON, ROYCE LEE JR (PA-C)
Entity Type:Individual
Prefix:
First Name:ROYCE
Middle Name:LEE
Last Name:HEFFINGTON
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-2019
Mailing Address - Country:US
Mailing Address - Phone:831-643-9788
Mailing Address - Fax:831-657-0161
Practice Address - Street 1:10 HARRIS CT BLDG A
Practice Address - Street 2:SUITE A1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5704
Practice Address - Country:US
Practice Address - Phone:831-643-9788
Practice Address - Fax:831-657-0161
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19587363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical