Basic Information
| Provider Information | |||||||||
| NPI: | 1407884034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEITMANN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 MEDICAL BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341101413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395130053 | ||||||||
| FaxNumber: | 2395960900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 MEDICAL BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341101413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395130053 | ||||||||
| FaxNumber: | 2395960900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | ME46943 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 048298600 | 05 | FL | MEDICAID |