Provider Demographics
NPI:1720039027
Name:HEATON, FRED M (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:M
Last Name:HEATON
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Gender:M
Credentials:DO
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Mailing Address - Street 1:111 NASON DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1212
Mailing Address - Country:US
Mailing Address - Phone:814-224-2213
Mailing Address - Fax:814-224-0005
Practice Address - Street 1:111 NASON DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1212
Practice Address - Country:US
Practice Address - Phone:814-224-2213
Practice Address - Fax:814-224-0005
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-09-26
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Provider Licenses
StateLicense IDTaxonomies
PAOS013765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine