Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D.5941 | AL |
NPI | 1023375235 |
---|---|
Provider Name | Brannon W Heape |
First Address | Wilmington, NC 28401-7352 |
Second Address | Opelika, AL 36801-7283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2012 |
Last Update Date | 29/05/2019 |