Provider Demographics
NPI:1942203104
Name:HEATH, WILLIAM ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERIC
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2229 MARY SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7633
Mailing Address - Country:US
Mailing Address - Phone:812-268-3318
Mailing Address - Fax:812-268-4017
Practice Address - Street 1:2229 MARY SHERMAN DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7633
Practice Address - Country:US
Practice Address - Phone:812-268-3318
Practice Address - Fax:812-268-4017
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049035A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200219540AMedicaid
IN200015680AMedicaid
IN153868Medicare ID - Type UnspecifiedRURAL HEATLH
IN153868Medicare Oscar/Certification