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General NPI Number Information
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NPI Number | 1992702336
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Entity Type | Individual
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Provider Name | KEVIN DAVID HEATH MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 455 HOGAN LN
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City | CONWAY
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State | AR
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Zip | 72034-8201
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Country | US
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Telephone | 501-513-0799
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Fax | 501-513-0798
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Provider Business Mailing Address
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Address Line | PO BOX 10780
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City | CONWAY
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State | AR
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Zip | 72034-0013
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Country | US
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Telephone | 501-513-0799
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Fax | 501-513-0798
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C6835
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License Number State | AR
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