Provider Demographics
NPI:1336238930
Name:HEIBERGER, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:HEIBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N ACADEMY BLVD
Mailing Address - Street 2:106
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-638-4548
Mailing Address - Fax:719-638-4571
Practice Address - Street 1:1304 N ACADEMY BLVD
Practice Address - Street 2:106
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-638-4548
Practice Address - Fax:719-638-4571
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO24223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080001911OtherR.R.MEDICARE
CO01242239Medicaid
COC810994Medicare PIN
CO080001911OtherR.R.MEDICARE
40501Medicare PIN