Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | DR.0066966 | CO |
N | 208800000X | Urologist | MED-PHYS-LIC-103596 | MT |
NPI | 1063866796 |
---|---|
Provider Name | Dr. Jerrod Tyler Heermans |
First Address | Kalispell, MT 59901-3167 |
Second Address | Kalispell, MT 59901-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 22/11/2021 |