Provider Demographics
NPI:1033119581
Name:HEYER, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:HEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 N 67TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1004
Mailing Address - Country:US
Mailing Address - Phone:623-561-4547
Mailing Address - Fax:632-412-4995
Practice Address - Street 1:10150 N 67TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1004
Practice Address - Country:US
Practice Address - Phone:623-561-4547
Practice Address - Fax:632-412-4995
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44038Medicare UPIN
AZZ139860Medicare PIN
AZZ62308Medicare ID - Type Unspecified