Provider Demographics
NPI:1225147481
Name:HEIMER, WILLIAM LENOX II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LENOX
Last Name:HEIMER
Suffix:II
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 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-944-7000
Mailing Address - Fax:760-944-1556
Practice Address - Street 1:320 SANTA FE DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-944-7000
Practice Address - Fax:760-944-1556
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85498207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G854980OtherBLUE CROSS/BLUE SHIELD
330900346OtherTRICARE
330900346OtherTRICARE
00G854980OtherBLUE CROSS/BLUE SHIELD