Provider Demographics
NPI:1578506010
Name:HEISE, RYAN H (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:H
Last Name:HEISE
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 1:801 E CAMPBELL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-6797
Mailing Address - Country:US
Mailing Address - Phone:214-377-3700
Mailing Address - Fax:
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3802
Practice Address - Country:US
Practice Address - Phone:972-600-2223
Practice Address - Fax:972-863-6020
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX389717ZG28Medicare PIN
TX389717ZG29Medicare PIN
TX166348602Medicaid
TX8J9739Medicare PIN
TX166348601Medicaid