Provider Demographics
NPI:1194119651
Name:HEBER, DEIDRE (DO)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:HEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 STATE ST STE 141
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6634
Mailing Address - Country:US
Mailing Address - Phone:207-973-4670
Mailing Address - Fax:207-973-4669
Practice Address - Street 1:417 STATE ST STE 141
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6634
Practice Address - Country:US
Practice Address - Phone:207-973-4670
Practice Address - Fax:207-973-4669
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019932207V00000X
390200000X
MEDO3468207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program