Provider Demographics
NPI:1780825182
Name:HEARD, DANIEL THOMPSON (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMPSON
Last Name:HEARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1602 N FARES AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-3952
Mailing Address - Country:US
Mailing Address - Phone:812-437-3784
Mailing Address - Fax:812-437-7155
Practice Address - Street 1:1602 N FARES AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-3952
Practice Address - Country:US
Practice Address - Phone:812-437-3784
Practice Address - Fax:812-437-7155
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003589A2083A0100X, 2083X0100X, 207QA0505X, 202C00000X, 204D00000X, 207QA0401X, 207QB0002X, 207QA0505X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7736166385OtherFMCSA / NRCME
ININ5616Medicaid
23-313744OtherMEDICAL REVIEW OFFICER (MEDICAL REVIEW OFFICER CERTIFICATION COUNCIL)