Provider Demographics
NPI:1619032687
Name:HECKARD, RALPH DUANE (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DUANE
Last Name:HECKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3908
Mailing Address - Country:US
Mailing Address - Phone:208-201-0795
Mailing Address - Fax:
Practice Address - Street 1:238 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3908
Practice Address - Country:US
Practice Address - Phone:208-201-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4388208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice