Provider Demographics
NPI:1972541126
Name:HEATHERS, ERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:HEATHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 S LAFOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3803
Mailing Address - Country:US
Mailing Address - Phone:765-864-5704
Mailing Address - Fax:765-864-5720
Practice Address - Street 1:3508 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3803
Practice Address - Country:US
Practice Address - Phone:765-864-5704
Practice Address - Fax:765-864-5720
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044350A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN562454401OtherSAGAMORE
IN562454401OtherM PLAN
IN562454401OtherAETNA
IN562454401OtherUNITED HEALTHCARE
IN562454401OtherTRICARE
IN562454401OtherADVANTAGE HEALTHCARE
INP00141244OtherR.R. MEDICARE
IN562454401OtherWASAU
IN000000342682OtherBLUE CROSS BLUE SHIELD
IN200062130AMedicaid
IN562454401OtherENCORE
IN562454401OtherCIGNA
IN562454401OtherHUMANA
IN562454401OtherSUBURBAN HEALTH
IN562454401OtherAARP
IN217900AMedicare PIN
ING01412Medicare UPIN