Doctor Name: | DR. JACOB WAYNE HECK |
NPI Number: | 1083916241 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | SC006058 |
Business Practice Address: | 1720 Cooks Hill Rd Centralia, WA - 985319071 |
Business Phone Number: | 3607362527 |
Business Fax Number: | |
Mailing Address: | 1720 Cooks Hill Rd, CENTRALIA |
State: | WA |
Postal Code: | 985319071 |
Phone Number: | 3607362527 |
Fax Number: | |
NPI Enumeration Date: | 11/22/2010 |
NPI Last Update Date: | 10/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | SC006058 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |