Healthcare Provider Details

I. General information

NPI: 1427465145
Provider Name (Legal Business Name): HEEKIN ORTHOPEDIC JOINT REPLACEMENT SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 RIVERSIDE AVE 3RD FLOOR
JACKSONVILLE FL
32204-4712
US

IV. Provider business mailing address

2627 RIVERSIDE AVE 3RD FLOOR
JACKSONVILLE FL
32204-4712
US

V. Phone/Fax

Practice location:
  • Phone: 904-634-0640
  • Fax: 904-674-0652
Mailing address:
  • Phone: 904-634-0640
  • Fax: 904-674-0652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME49020
License Number StateFL

VIII. Authorized Official

Name: RICHARD DAVID HEEKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 904-634-0640