Provider Demographics
NPI:1750388484
Name:O'HEIR, DOUGLAS A (DPM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:O'HEIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5833
Mailing Address - Country:US
Mailing Address - Phone:207-872-2262
Mailing Address - Fax:207-872-8411
Practice Address - Street 1:143 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5833
Practice Address - Country:US
Practice Address - Phone:207-872-2262
Practice Address - Fax:207-872-8411
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD175213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114490099Medicaid
MET131461Medicare UPIN
ME114490099Medicaid