TRACE HEAVENER

COEUR D ALENE, ID
NPI1841646726
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207RG0100X Internal Medicine, Gastroenterology
(Licence: ID  O-1809)
Enumeration Date2016-05-10
Last Update Date2025-05-06
Business Address
TRACE HEAVENER D.O.
1919 LINCOLN WAY STE 415
COEUR D ALENE, ID 83814-2527
Phone number: 208-625-4595
Mailing Address
TRACE HEAVENER D.O.
2003 KOOTENAI HEALTH WAY
COEUR D ALENE, ID 83814-6051
Phone number: 208-625-4595
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