Provider Demographics
NPI:1457362899
Name:HEINEN, BRIAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:N
Last Name:HEINEN
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 1:151 LEON AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3917
Mailing Address - Country:US
Mailing Address - Phone:337-457-8166
Mailing Address - Fax:888-371-3069
Practice Address - Street 1:151 LEON AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3917
Practice Address - Country:US
Practice Address - Phone:337-457-8166
Practice Address - Fax:337-457-8564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1112704Medicaid
LA1112704Medicaid
LAB60391Medicare UPIN