Individual
DR. ROBERT EVANS HEITHAUS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 SW ARCHER RD, 100374, GAINESVILLE, FL 32610-0374
(352) 265-0291
Mailing address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
(407) 849-6470
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
ME130211
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME130211
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024688800
—
FL
01
—
E8Y3I
BCBS
FL
01
—
JK675Y
MEDICARE PTAN OHRI
FL
01
—
PS295
MEDICARE PTAN OHMG
FL
Enumeration date
04/10/2012
Last updated
03/27/2023
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