Individual
LARRY TRAVIS HEAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
606 N MAIN ST, EAGAR, AZ 85925-9813
(928) 333-5333
(928) 333-5100
Mailing address
PO BOX 1610, SPRINGERVILLE, AZ 85938-1610
(928) 333-5333
(928) 333-5100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3048
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
933467
—
AZ
Enumeration date
02/23/2006
Last updated
11/21/2007
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