Provider Demographics
NPI:1417992967
Name:HEERING, SAMUEL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEE
Last Name:HEERING
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:PO BOX 880346
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33488-0346
Mailing Address - Country:US
Mailing Address - Phone:561-218-0767
Mailing Address - Fax:561-218-3757
Practice Address - Street 1:2500 MILITARY TRAIL
Practice Address - Street 2:SUITE 111
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-218-0767
Practice Address - Fax:561-218-3757
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69832207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31933AMedicare ID - Type UnspecifiedPHYSICIAN