Provider Demographics
NPI:1821062928
Name:HERON MD PA, PATRICK H (MD PA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:H
Last Name:HERON MD PA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9290 SW 72ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3236
Mailing Address - Country:US
Mailing Address - Phone:305-412-9825
Mailing Address - Fax:305-412-9925
Practice Address - Street 1:9290 SW 72ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3236
Practice Address - Country:US
Practice Address - Phone:305-412-9825
Practice Address - Fax:305-412-9925
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME83551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9216362OtherCIGNA
FL291235OtherAVMED
FL71074OtherBLUE CROSS BLUE SHIELD
FL268097100Medicaid
FL268097100Medicaid
FL9216362OtherCIGNA