Provider Demographics
NPI:1457313728
Name:HEIDENREICH, JOSEPH W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:HEIDENREICH
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 1:1030 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6730
Mailing Address - Country:US
Mailing Address - Phone:254-931-9802
Mailing Address - Fax:
Practice Address - Street 1:1030 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-6730
Practice Address - Country:US
Practice Address - Phone:254-931-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S6324OtherBLUE SHIELD
TX1761629-01Medicaid
TX1761629-02OtherCSHCN
TX8D9217Medicare ID - Type Unspecified
TXI41265Medicare UPIN