Provider Demographics
NPI:1962840504
Name:HEISE, WILL D (MD)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:D
Last Name:HEISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15679 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8592
Mailing Address - Country:US
Mailing Address - Phone:405-390-1800
Mailing Address - Fax:405-390-3846
Practice Address - Street 1:15679 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8592
Practice Address - Country:US
Practice Address - Phone:405-390-1800
Practice Address - Fax:405-390-3846
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046113207Q00000X
OK32026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine