Provider Demographics
NPI:1255314191
Name:HELLER, WARREN HARVEY (M D)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:HARVEY
Last Name:HELLER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W BUCKEYE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-2647
Mailing Address - Country:US
Mailing Address - Phone:602-257-8280
Mailing Address - Fax:602-257-7007
Practice Address - Street 1:515 W BUCKEYE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-3699
Practice Address - Country:US
Practice Address - Phone:602-257-8280
Practice Address - Fax:602-257-7007
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8149174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ211491Medicaid
AZZWCLGD01Medicare PIN