Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038.011037 | IL |
N | 111N00000X | Chiropractor | 3343 | NC |
N | 111NR0200X | Radiology | CFC 9 | FL |
N | 213ER0200X | Radiology | CFC 9 | FL |
Y | 111NR0200X | Radiology | CH 10315 | FL |
Y | 213ER0200X | Radiology | CH 10315 | FL |
NPI | 1639181621 |
---|---|
Provider Name | Dr. Rudy N Heiser |
First Address | Saint Petersburg, FL 33713-9054 |
Second Address | Pinellas Park, FL 33781-4005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
085VP | BLUEBROSS BLUESHIELD (01) | |
5900616 | (05) | NC |
V05319 | (02) |