Provider Demographics
NPI:1710987839
Name:HEISER, DONALD R (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:HEISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9724 KINGSTON PIKE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3347
Mailing Address - Country:US
Mailing Address - Phone:865-690-0602
Mailing Address - Fax:865-690-0515
Practice Address - Street 1:7557 DANNAHER LN
Practice Address - Street 2:SUITE 230
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3558
Practice Address - Country:US
Practice Address - Phone:865-938-5222
Practice Address - Fax:865-938-5264
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000009402208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1669416442OtherGROUP NPI
TN3171062Medicaid
TN3106082OtherBLUE CROSS
TNCI2260OtherRAILROAD MEDICARE
TN020253199OtherEEOCIP
TN3106070OtherBLUE CROSS
TN1260440001Medicare NSC
TN020253199OtherEEOCIP
TNB03443Medicare UPIN
TN3714755Medicare PIN
TN3171062Medicaid