=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851625800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARVIN ARTHUR HEUER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2009
-----------------------------------------------------
Last Update Date | 09/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6001 VINELAND RD SUITE 104
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-574-5650
-----------------------------------------------------
Fax | 407-362-6292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4630 S KIRKMAN RD SUITE 368
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32811-2833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-574-5650
-----------------------------------------------------
Fax | 407-362-6292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME72101
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------