Provider Demographics
NPI:1750380861
Name:HEISER, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:HEISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MERCY DR NW
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2626
Mailing Address - Country:US
Mailing Address - Phone:330-456-6760
Mailing Address - Fax:330-452-4557
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:SUITE 510
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-456-6760
Practice Address - Fax:330-452-4557
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2009-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35078029208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4027636Medicare ID - Type Unspecified
4027639Medicare ID - Type Unspecified
F20077Medicare UPIN
4027638Medicare ID - Type Unspecified
4027635Medicare ID - Type Unspecified
4027637Medicare ID - Type Unspecified