Provider Demographics
NPI:1023111812
Name:HEITZMAN, HARRY BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:BRADLEY
Last Name:HEITZMAN
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 1:1131 OCEAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-872-3191
Mailing Address - Fax:228-872-3676
Practice Address - Street 1:1131 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-872-3191
Practice Address - Fax:228-872-3676
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0063567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
640924556OtherEIN
MS110001313Medicare ID - Type Unspecified
MSB29978Medicare UPIN