Provider Demographics
NPI:1427322320
Name:HEAP, JAMES RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:HEAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1247
Mailing Address - Country:US
Mailing Address - Phone:419-629-2311
Mailing Address - Fax:419-629-9232
Practice Address - Street 1:44 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-1247
Practice Address - Country:US
Practice Address - Phone:419-629-2311
Practice Address - Fax:419-629-9232
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.0667382083X0100X
NY1861162083X0100X
CAG615402083X0100X
TXG16722083X0100X
AZ114182083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine