Provider Demographics
NPI:1821087636
Name:HEITKAMP, JEFFREY W (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:HEITKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 152679
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8679
Mailing Address - Country:US
Mailing Address - Phone:817-274-4593
Mailing Address - Fax:817-274-4098
Practice Address - Street 1:811 W INTERSTATE 20 UNIT G10
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5871
Practice Address - Country:US
Practice Address - Phone:817-274-4593
Practice Address - Fax:817-274-4098
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2021-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF4064207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314595OtherCIGNA
TX0610290OtherAETNA
TX00FM69OtherMEDICARE
TX80A470OtherBCBS OF TEXAS
TX0610290OtherAETNA