Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 11803 | NE |
Y | 208600000X | Surgeon | 11803 | NE |
NPI | 1023092277 |
---|---|
Provider Name | Dr. John J Heieck |
First Address | Omaha, NE 68114-3302 |
Second Address | Omaha, NE 68114-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B67703 | (02) | NE |