Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 5594 | MD |
NPI | 1659353423 |
---|---|
Provider Name | Dr. John J Heffron |
First Address | Waldorf, MD 20602-3248 |
Second Address | Waldorf, MD 20602-3248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 07/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T31112 | (02) | MD |