Provider Demographics
NPI:1295719870
Name:HEREDIA, FRANKLIN O (MD)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:O
Last Name:HEREDIA
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:4545 FULLER DRIVE
Practice Address - Street 2:SUITE 325
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6521
Practice Address - Country:US
Practice Address - Phone:972-870-5511
Practice Address - Fax:972-870-5512
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106257209Medicaid
TX106257215Medicaid
TX106257222Medicaid
TX84675FOtherBLUE CROSS BLUE SHIELD
TX106257204Medicaid
TX106257205Medicaid
TX106257219Medicaid
TX106257213Medicaid
TX106257207Medicaid
TX106257221Medicaid
TX106257201Medicaid
TX106257211Medicaid
TX106257216Medicaid
TX106257218Medicaid
TX106257222Medicaid
TX106257215Medicaid