Healthcare Provider Details

I. General information

NPI: 1942364609
Provider Name (Legal Business Name): JAMES JOHN HERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 FISHER ST
MARQUETTE MI
49855-4521
US

IV. Provider business mailing address

449 W HEWITT AVE
MARQUETTE MI
49855-3321
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-3576
  • Fax: 906-226-9533
Mailing address:
  • Phone: 906-228-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301043907
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: