Provider Demographics
NPI:1477517233
Name:HEEKIN, RICHARD DAVID (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:HEEKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 RIVESIDE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4762
Mailing Address - Country:US
Mailing Address - Phone:904-328-5979
Mailing Address - Fax:904-619-9925
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 605, DEPAUL BLDG
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-328-5979
Practice Address - Fax:904-619-9925
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49020174400000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200041157OtherRAILROAD MEDICARE
FL421464000Medicaid
FL421464000Medicaid
FL25109YMedicare PIN
FLF35673Medicare UPIN
FL25109Medicare PIN