Provider Demographics
NPI:1518489095
Name:HEATH, WAYNE ANTHONY JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ANTHONY
Last Name:HEATH
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:184 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-4432
Mailing Address - Country:US
Mailing Address - Phone:207-926-4488
Mailing Address - Fax:
Practice Address - Street 1:152 DRESDEN AVE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2615
Practice Address - Country:US
Practice Address - Phone:207-582-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant