Provider Demographics
NPI:1578647319
Name:HEINE, GEARY A (MD,)
Entity Type:Individual
Prefix:
First Name:GEARY
Middle Name:A
Last Name:HEINE
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 LINDER WAY NW
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9149
Mailing Address - Country:US
Mailing Address - Phone:360-307-7010
Mailing Address - Fax:360-307-9170
Practice Address - Street 1:9395 LINDER WAY NW
Practice Address - Street 2:SUITE # 202
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9149
Practice Address - Country:US
Practice Address - Phone:360-307-7010
Practice Address - Fax:360-307-9170
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA262882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E17784Medicare UPIN
WAGAB0619Medicare ID - Type Unspecified