Provider Demographics
NPI:1467447201
Name:HERIOT, JAMES HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:HERIOT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 INDEPENDENCE DRIVE
Mailing Address - Street 2:14TH MEDICAL GROUP/SGOQ
Mailing Address - City:COLUMBUS AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39710
Mailing Address - Country:US
Mailing Address - Phone:662-434-2216
Mailing Address - Fax:662-434-2128
Practice Address - Street 1:201 INDEPENDENCE DRIVE
Practice Address - Street 2:14TH MEDICAL GROUP/SGOQ
Practice Address - City:COLUMBUS AFB
Practice Address - State:MS
Practice Address - Zip Code:39710
Practice Address - Country:US
Practice Address - Phone:662-434-2216
Practice Address - Fax:662-434-2128
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0071966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN