Provider Demographics
NPI: | 1518312461 |
---|---|
Name: | O'FIELD, HEATHER ASHLEY (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HEATHER |
Middle Name: | ASHLEY |
Last Name: | O'FIELD |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | HEATHER |
Other - Middle Name: | ASHLEY |
Other - Last Name: | SHAFFER |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 920 DOUG WHITE DR STE 210 |
Mailing Address - Street 2: | |
Mailing Address - City: | MYRTLE BEACH |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29572-4181 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-497-6348 |
Mailing Address - Fax: | 843-497-6351 |
Practice Address - Street 1: | 920 DOUG WHITE DR STE 210 |
Practice Address - Street 2: | |
Practice Address - City: | MYRTLE BEACH |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29572-4181 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-497-6348 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-04-28 |
Last Update Date: | 2023-12-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 90675 | 208600000X, 2086S0102X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |