Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 15345 | NH |
Y | 207QS0010X | Family Doctor - Sports Medicine | 15345 | NH |
N | 208D00000X | General Practice Physician | 233312 | MA |
NPI | 1225202237 |
---|---|
Provider Name | Kevin Douglas Heaton |
First Address | Exeter, NH 03833-4848 |
Second Address | Exeter, NH 03833-4848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 17/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3077761 | (05) | NH |