Provider Demographics
NPI:1851330039
Name:HEYNE, TIMOTHY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:HEYNE
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 1:611 ABBOTT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4314
Mailing Address - Country:US
Mailing Address - Phone:831-757-3041
Mailing Address - Fax:831-757-4612
Practice Address - Street 1:611 ABBOTT ST STE 101
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4314
Practice Address - Country:US
Practice Address - Phone:831-757-3041
Practice Address - Fax:831-757-4612
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A16872Medicare UPIN
CA00G661000Medicare ID - Type Unspecified