Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD12524 | RI |
Y | 208600000X | Surgeon | MD12524 | RI |
N | 2086S0102X | Surgical Critical Care | 42633 | TN |
N | 2086S0127X | Trauma Surgeon | 42633 | TN |
N | 2086S0127X | Trauma Surgeon | MD12524 | RI |
NPI | 1144377961 |
---|---|
Provider Name | David James Heffernan |
First Address | Rumford, RI 02916-0697 |
Second Address | Providence, RI 02905-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 29/01/2020 |