Provider Demographics
NPI:1538141759
Name:HEDDLESON, JAMES D (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:HEDDLESON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4535 DRESSLER RD NW
Mailing Address - Street 2:HOSPITALISTS MANAGEMENT GROUP
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2545
Mailing Address - Country:US
Mailing Address - Phone:330-497-8490
Mailing Address - Fax:330-497-8496
Practice Address - Street 1:335 GLESSNER AVE
Practice Address - Street 2:MEDCENTRAL HOSPITAL
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2269
Practice Address - Country:US
Practice Address - Phone:419-520-2379
Practice Address - Fax:419-520-2824
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-10-05
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Provider Licenses
StateLicense IDTaxonomies
OH34008176207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539944Medicaid
OH34008176OtherOHIO STATE LICENSE
OH34008176OtherOHIO STATE LICENSE
OHI15815Medicare UPIN