Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 6698 | MT |
NPI | 1003836164 |
---|---|
Provider Name | David B Heetderks |
First Address | Helena, MT 59601-4915 |
Second Address | Helena, MT 59601-4915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0086463 | (05) | MT |
E48215 | (02) | MT |