Healthcare Provider Details

I. General information

NPI: 1013902733
Provider Name (Legal Business Name): DAVID J HEANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN DAVID HEANEY M.D.

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W ACEQUIA AVE STE A
VISALIA CA
93291-6131
US

IV. Provider business mailing address

515 W ACEQUIA AVE STE A
VISALIA CA
93291-6131
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-9707
  • Fax: 559-733-7009
Mailing address:
  • Phone: 559-733-9707
  • Fax: 559-733-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA301420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA301420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: