Provider Demographics
NPI:1629267430
Name:DAVID R HEIMAN M D P A
Entity Type:Organization
Organization Name:DAVID R HEIMAN M D P A
Other - Org Name:DAVID R HEIMAN M D P A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-3913
Mailing Address - Street 1:4224 N TAMPANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6322
Mailing Address - Country:US
Mailing Address - Phone:813-877-3913
Mailing Address - Fax:813-876-4793
Practice Address - Street 1:4224 N TAMPANIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6322
Practice Address - Country:US
Practice Address - Phone:813-877-3913
Practice Address - Fax:813-876-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060847207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG944Medicare PIN