Healthcare Provider Details

I. General information

NPI: 1154333540
Provider Name (Legal Business Name): JONATHAN S HEARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 FOLKS RD
LAWRENCE KS
66049-9724
US

IV. Provider business mailing address

724 FOLKS RD
LAWRENCE KS
66049-9724
US

V. Phone/Fax

Practice location:
  • Phone: 213-598-9069
  • Fax: 785-856-2011
Mailing address:
  • Phone: 213-598-9069
  • Fax: 785-856-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG59961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG59961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: