Provider Demographics
NPI:1740214840
Name:YECKES-RODIN, HEATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:YECKES-RODIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 S. E. TIFFANY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7596
Mailing Address - Country:US
Mailing Address - Phone:772-355-5666
Mailing Address - Fax:772-335-3781
Practice Address - Street 1:1871 S. E. TIFFANY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7596
Practice Address - Country:US
Practice Address - Phone:772-355-5666
Practice Address - Fax:772-335-3781
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219188207RH0003X
FLME97999207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279770400Medicaid
FL05438OtherBS
FLAH447ZMedicare PIN