Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 9585 | OH |
NPI | 1164634689 |
---|---|
Provider Name | Dr. Matthew W Heckler |
First Address | Cincinnati, OH 45271-0001 |
Second Address | Centerville, OH 45459-3475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 07/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3046448 | (05) | OH |
P00871995 | RR MEDICARE (01) | OH |