Provider Demographics
NPI:1518937952
Name:HEINRICH, E MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:E
Middle Name:MATTHEW
Last Name:HEINRICH
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 1:4611 GUADALUPE ST
Mailing Address - Street 2:#200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2908
Mailing Address - Country:US
Mailing Address - Phone:512-583-4220
Mailing Address - Fax:512-583-1099
Practice Address - Street 1:4611 GUADALUPE ST
Practice Address - Street 2:#200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2908
Practice Address - Country:US
Practice Address - Phone:512-583-4220
Practice Address - Fax:512-583-1099
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7760207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039120302Medicaid
TXH30257Medicare UPIN
TX8C0732Medicare ID - Type Unspecified