Provider Demographics
NPI:1386636934
Name:HEARD, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:HEARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21600 HWY 99
Mailing Address - Street 2:STE 255
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8047
Mailing Address - Country:US
Mailing Address - Phone:425-774-2628
Mailing Address - Fax:425-774-2676
Practice Address - Street 1:21600 HWY 99
Practice Address - Street 2:SUITE 255
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8012
Practice Address - Country:US
Practice Address - Phone:425-774-2628
Practice Address - Fax:425-774-2676
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA000154142081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922905Medicaid
WA18297OtherWORKER'S COMP
WAAO6312Medicare UPIN