Provider Demographics
NPI:1538129424
Name:HELLER, HOWARD J (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:HELLER
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 1:3417 GASTON AVE
Mailing Address - Street 2:SUITE 980
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2016
Mailing Address - Country:US
Mailing Address - Phone:469-800-8020
Mailing Address - Fax:469-800-8030
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 980
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2016
Practice Address - Country:US
Practice Address - Phone:469-800-8020
Practice Address - Fax:469-800-8030
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8119207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046974401Medicaid
8F3914Medicare PIN
G30105Medicare UPIN
88G090Medicare ID - Type Unspecified
TX046974401Medicaid