Provider Demographics
NPI:1437428091
Name:HERON, GEORGE (EP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:HERON
Suffix:
Gender:M
Credentials:EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 HARRISON BLVD
Mailing Address - Street 2:MCKAY-DEE HOSPITAL
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3195
Mailing Address - Country:US
Mailing Address - Phone:801-387-3062
Mailing Address - Fax:801-387-3094
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:MCKAY-DEE HOSPITAL
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-3062
Practice Address - Fax:801-387-3094
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist