Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO60228667 | WA |
N | 213ES0103X | Foot & Ankle Surgery | SC006058 | PA |
NPI | 1083916241 |
---|---|
Provider Name | Dr. Jacob Wayne Heck |
First Address | Centralia, WA 98531-9071 |
Second Address | Centralia, WA 98531-9071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2010 |
Last Update Date | 02/10/2012 |