MEDICARE: ERIK DOUGLAS HIESTER DO

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	230204	NY
2	207Q00000X	Family Medicine Physician	230204	NY
3	207Q00000X	Family Medicine Physician	OS12128	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HF963Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14Q1Y	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588673495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK DOUGLAS HIESTER DO

Provider Business Mailing Address
First Line	:	PO BOX 25487
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-2487
Country	:	US
Telephone Number	:	941-202-5342
Fax Number	:	855-253-4836

Provider Business Practice Location Address
First Line	:	7273 VANDERBILT BEACH RD STE 28
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-1479
Country	:	US
Telephone Number	:	239-306-5390
Fax Number	:	239-306-5399

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	12/23/2020

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Directions to “ ERIK DOUGLAS HIESTER DO” Practice Location

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