Basic Information
| Provider Information | |||||||||
| NPI: | 1477517233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEEKIN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1045 RIVESIDE AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043285979 | ||||||||
| FaxNumber: | 9046199925 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 SHIRCLIFF WAY | ||||||||
| Address2: | SUITE 605, DEPAUL BLDG | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043285979 | ||||||||
| FaxNumber: | 9046199925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME49020 | FL | N | Other Service Providers | Specialist | 207XS0114X | ME49020 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200041157 | 01 | FL | RAILROAD MEDICARE | OTHER | 421464000 | 05 | FL | MEDICAID |