Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7970 | IA |
NPI | 1013011485 |
---|---|
Provider Name | James M Heit |
First Address | Council Bluffs, IA 51503-4643 |
Second Address | Omaha, NE 68164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0184119 | (05) | IA |
U77905 | (02) |