Provider Demographics
NPI:1013902733
Name:HEANEY, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HEANEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:DAVID
Other - Last Name:HEANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:515 W ACEQUIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6131
Mailing Address - Country:US
Mailing Address - Phone:559-733-9707
Mailing Address - Fax:559-733-7009
Practice Address - Street 1:515 W ACEQUIA AVE STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6131
Practice Address - Country:US
Practice Address - Phone:559-733-9707
Practice Address - Fax:559-733-7009
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA301420207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A301420Medicaid
CA1013123686OtherNPPES-TULARE LOCATION
CA1972710127OtherNPPES-PORTERVILLE LOC.
CA942512154OtherFED TAX ID #
CA05D0864240OtherCLIA NUMBER
CA1588879175OtherNPPES-VISALIA LOCATION
CAA30142OtherCALIF. MEDICAL BOARD
CA1972710127OtherNPPES-PORTERVILLE LOC.
CA942512154OtherFED TAX ID #
CA00A301420Medicaid