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NPI Code Detail

MEDICARE: DR. ROBERT B HEACOX

MEDICARE: DR. ROBERT B HEACOX
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
1207P00000XEmergency Medicine Physician4301037474MI

General Provider Information

NPI Number : 1750487054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT B HEACOX
Provider Business Mailing Address
First Line : 102 W ANN STREET
Second Line :
City : SPRING LAKE
State : MI
Zip : 49456-1867
Country : US
Telephone Number : 616-566-8404
Fax Number :
Provider Business Practice Location Address
First Line : 675 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1887
Country : US
Telephone Number : 800-366-1884
Fax Number : 801-487-8197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 03/30/2011

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