Provider Demographics
NPI:1396727178
Name:AULD, HEATHER V (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:V
Last Name:AULD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1031
Mailing Address - Country:US
Mailing Address - Phone:239-208-6676
Mailing Address - Fax:392-086-6762
Practice Address - Street 1:1570 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1031
Practice Address - Country:US
Practice Address - Phone:239-208-6676
Practice Address - Fax:392-086-6762
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58032207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000011209MOtherHUMANA
FL12565OtherBC/BS OF FLORIDA
FL15625OtherSTAYWELL
FL212935OtherAVMED
FL212935OtherAVMED
FL12565ZMedicare ID - Type Unspecified
FL054435300Medicaid