Basic Information
| Provider Information | |||||||||
| NPI: | 1174793848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEWARD | ||||||||
| FirstName: | FINTAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | IDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 CHLID STREET | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322140001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045423500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 250 CHILD STREET | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322140001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045423500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2008 | ||||||||
| LastUpdateDate: | 03/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1103X | Y | Ambulatory Health Care Facilities | Clinic/Center | Military Ambulatory Procedure Visits Operational (Transportable) |
No ID Information.