Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 213765 | NY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 213765 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 213765 | NY |
NPI | 1407965346 |
---|---|
Provider Name | Dr. Brian Heppard |
First Address | Rochester, NY 14621-3065 |
Second Address | Rochester, NY 14621-3065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 20/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02165548 | (05) | NY |
H00499 | (02) | NY |