Provider Demographics
NPI:1588673495
Name:HIESTER, ERIK DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:DOUGLAS
Last Name:HIESTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:7273 VANDERBILT BEACH RD STE 28
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-1479
Practice Address - Country:US
Practice Address - Phone:239-306-5390
Practice Address - Fax:239-306-5399
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230204207LP2900X, 207Q00000X
FLOS12128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHF963ZOtherMEDICARE
FL008741800Medicaid
FL14Q1YOtherBCBS
FL008741800Medicaid
FLHF963ZMedicare PIN
FLHF963ZOtherMEDICARE