Individual
DR. LAURA LYNN HEIMBACK-GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME112872
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010074902
UNIVERA
—
01
—
000500480004
BC/BS
—
01
—
000500480005
BC/BS
—
05
—
0019433420001
—
PA
05
—
0065758-00
—
FL
05
—
00850591
—
NY
01
—
040426002037
FIDELIS
—
01
—
08047000068
FIDELIS
—
01
—
1211500
IHA
—
Enumeration date
06/09/2006
Last updated
07/21/2022
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