Provider Demographics
NPI:1508103250
Name:HECKMAN, BOBBY M
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:M
Last Name:HECKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 CHIEF EDDIE HOFFMAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6160
Mailing Address - Fax:907-543-6143
Practice Address - Street 1:5089 AIRPORT STREET
Practice Address - Street 2:
Practice Address - City:PILOT STATION
Practice Address - State:AK
Practice Address - Zip Code:99650-5089
Practice Address - Country:US
Practice Address - Phone:907-549-3127
Practice Address - Fax:907-549-3738
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker