Provider Demographics
NPI:1366583486
Name:PATRICK H HERON MD PA
Entity type:Organization
Organization Name:PATRICK H HERON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:HYLTON
Authorized Official - Last Name:HERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA,FACOG
Authorized Official - Phone:305-412-9825
Mailing Address - Street 1:9290 SW 72ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3236
Mailing Address - Country:US
Mailing Address - Phone:305-412-9825
Mailing Address - Fax:305-412-9925
Practice Address - Street 1:9290 SW 72ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3236
Practice Address - Country:US
Practice Address - Phone:305-412-9825
Practice Address - Fax:305-412-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 83551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291235OtherAVMED
FL268097100Medicaid
FL71074OtherBLU CROSS BLUE SHIELD
FL71074OtherBLU CROSS BLUE SHIELD
FL268097100Medicaid
FL268097100Medicaid