Provider Demographics
NPI:1255398061
Name:HEIMBECKER, DANIEL A (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:HEIMBECKER
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 1:1506 FLOYD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-9009
Mailing Address - Country:US
Mailing Address - Phone:325-212-5364
Mailing Address - Fax:
Practice Address - Street 1:608 AVENUE B
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2406
Practice Address - Country:US
Practice Address - Phone:325-365-2531
Practice Address - Fax:325-365-2662
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8153207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137702014Medicaid
TX137702006Medicaid
TX8P9630OtherBLUE CROSS/BLUESHIELD TX