Provider Demographics
NPI:1396719266
Name:HEIMBECKER, PAUL MARK (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MARK
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 1:127 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3917
Mailing Address - Country:US
Mailing Address - Phone:919-776-7640
Mailing Address - Fax:919-776-2956
Practice Address - Street 1:127 N STEELE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3917
Practice Address - Country:US
Practice Address - Phone:919-776-7640
Practice Address - Fax:919-776-2956
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56399207V00000X
IAMD-48228207V00000X
NC9400524207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2202200EOtherMEDICARE
NC0738842OtherUNITED HEALTH CARE
NC1396719266Medicaid
NC43593OtherBLUE CROSS
NC5553011OtherAETNA
NC8943593Medicaid
NCC1849OtherMEDCOST
FLME105286OtherMEDICAL LICENSE
NC0738842OtherUNITED HEALTH CARE
NC8943593Medicaid
FLDL462ZOtherMEDICARE