Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 05181 | IA |
N | 207L00000X | Anesthesiologist | 1198 | SC |
Y | 207L00000X | Anesthesiologist | 2011008545 | MO |
N | 207L00000X | Anesthesiologist | 2272 | NE |
N | 207L00000X | Anesthesiologist | 34.009378 | OH |
NPI | 1013183631 |
---|---|
Provider Name | John Ashton Heckathorn II |
First Address | Springfield, MO 65804-2203 |
Second Address | Omaha, NE 68124-2319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2008 |
Last Update Date | 05/05/2021 |