Individual
DR. ERIC J. HEATHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3508 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 864-5704
(765) 864-5720
Mailing address
3508 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 864-5704
(765) 864-5720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044350A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342682
BLUE CROSS BLUE SHIELD
IN
05
—
200062130A
—
IN
01
—
562454401
SAGAMORE
IN
01
—
P00141244
R.R. MEDICARE
IN
Enumeration date
06/02/2006
Last updated
08/06/2019
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