Provider Demographics
NPI:1790764611
Name:HEINRICHS, GENE W (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:W
Last Name:HEINRICHS
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 1:1427 CIRCLE DR E
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2966
Mailing Address - Country:US
Mailing Address - Phone:559-281-4020
Mailing Address - Fax:559-292-3284
Practice Address - Street 1:1427 CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2966
Practice Address - Country:US
Practice Address - Phone:559-281-4020
Practice Address - Fax:559-292-3284
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C266140Medicaid
CA00C266140Medicaid
00C266140Medicare PIN