Provider Demographics
NPI:1619959673
Name:HEIDEPRIEM, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:HEIDEPRIEM
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 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:
Practice Address - Street 1:1405 CENTERVILLE RD STE 5000
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4663
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1599682086S0129X
AL000238462086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51544310OtherBLUE CROSS - PRINCETON
AL1700875OtherMEDICARE COMPLETE
AL51590936OtherBLUE CROSS- SHELBY
ALH85594OtherVIVA
ALP00381059OtherRR MEDICARE
AL2081367OtherCIGNA
AL208500240OtherAETNA
AL51540027OtherBLUE CROSS-TRINITY
AL009941562Medicaid
AL1700875OtherUNITED HEALTHCARE
AL51539627OtherBLUE CROSS-
AL51540026OtherBLUE CROSS- ST VINCENTS
AL1700875OtherUNITED HEALTHCARE