Provider Demographics
NPI:1740449677
Name:HEIMAN, JONATHAN NEAL (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NEAL
Last Name:HEIMAN
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:59101 AMBER STREET
Practice Address - Street 2:CHILDREN'S INTERNATIONAL, LLC
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-2865
Practice Address - Country:US
Practice Address - Phone:958-646-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1093335Medicaid