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General NPI Number Information
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NPI Number | 1437221918
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Entity Type | Individual
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Provider Name | JESSE JACOB HEER M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 4301 WILSON ST
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City | FORT SILL
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State | OK
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Zip | 73503-4472
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Country | US
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Telephone | 580-558-2680
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Fax |
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Provider Business Mailing Address
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Address Line | 6631 NE WATTS RD
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City | ELGIN
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State | OK
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Zip | 73538-2343
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Country | US
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Telephone | 580-695-6068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | TRN10435
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License Number State | FL
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