Provider Demographics
NPI:1619910684
Name:HERAS, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HERAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 W 50 N STE 14
Mailing Address - Street 2:CRENDENTIALING DEPARTMENT
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2266
Mailing Address - Country:US
Mailing Address - Phone:801-492-7662
Mailing Address - Fax:801-492-7663
Practice Address - Street 1:482 W 50 N
Practice Address - Street 2:SUITE 14
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2266
Practice Address - Country:US
Practice Address - Phone:801-492-7662
Practice Address - Fax:801-492-7663
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370655-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT243245OtherALTIUS
UT84316OtherPEHP
UT870281028000Medicaid
P00264029OtherPALMETTO GBA
UT10-00197OtherUNITED HEALTHCARE
UT581492OtherDMBA
UT870281028HEROtherEMIA
UTH01181Medicare UPIN
UT005502597Medicare ID - Type UnspecifiedMEDICARE