Provider Demographics
NPI:1790707883
Name:HEFFEL, DOMINIC F (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:F
Last Name:HEFFEL
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 1:3501 SOUTH SONCY ROAD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-3239
Mailing Address - Country:US
Mailing Address - Phone:310-625-6271
Mailing Address - Fax:
Practice Address - Street 1:3501 S SONCY RD STE 126
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6406
Practice Address - Country:US
Practice Address - Phone:806-322-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC352222086S0122X
TXS38192086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8035868OtherCIGNA
SCSC03138552OtherMEDICARE PTAN
SC261446OtherMEDCOST
SC7636447OtherAETNA
SC352228Medicaid