Individual
JERRY D HEADDY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 355-3299
(812) 355-3290
Mailing address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 355-3299
(812) 355-3290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01039529A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100185080
—
IN
Enumeration date
06/16/2005
Last updated
12/15/2020
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