Provider Demographics
NPI:1437133139
Name:HEITZ, JULIAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:C
Last Name:HEITZ
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:PO BOX 440261
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0261
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:
Practice Address - Street 1:2011 CHURCH ST
Practice Address - Street 2:LOWER LEVEL PLAZA 1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2000
Practice Address - Country:US
Practice Address - Phone:615-284-7785
Practice Address - Fax:615-284-7791
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN188602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3193118Medicaid
TN3721492Medicaid
TN3193118Medicaid
TN3193111Medicare ID - Type UnspecifiedRA
TN3721492Medicare ID - Type UnspecifiedRA GROUP
TN3721492Medicaid