MEDICARE: DR. HEATHER V AULD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME58032	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000011209M	OTHER	FL	HUMANA
2	12565	OTHER	FL	BC/BS OF FLORIDA
3	15625	OTHER	FL	STAYWELL
4	212935	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1396727178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER V AULD M.D.

Provider Business Mailing Address
First Line	:	1570 COLONIAL BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1031
Country	:	US
Telephone Number	:	239-208-6676
Fax Number	:	392-086-6762

Provider Business Practice Location Address
First Line	:	1570 COLONIAL BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1031
Country	:	US
Telephone Number	:	239-208-6676
Fax Number	:	392-086-6762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/10/2020

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