Provider Demographics
NPI:1821071648
Name:HEINBERG, ERIC M (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:HEINBERG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4396
Practice Address - Country:US
Practice Address - Phone:206-215-3500
Practice Address - Fax:206-215-6499
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024232208600000X
LAMD.024232208600000X
WAMD00046709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7009911Medicaid
LA1577235Medicaid
MS09633591Medicaid
LAH62041Medicare UPIN
MS09633591Medicaid
LA4Q6807061Medicare PIN