Provider Demographics
NPI:1396808903
Name:HEINER, DAVID ROBERT (MD PC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:HEINER
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:R
Other - Last Name:HEINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:945 W HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-637-7727
Mailing Address - Fax:435-637-1387
Practice Address - Street 1:945 W HOSPITAL DRIVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-7727
Practice Address - Fax:435-637-1387
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1683318905207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1683311205OtherST LICENSE NUMBER
UT1683311205OtherST LICENSE NUMBER
UTAH8252001OtherDEA