Provider Demographics
NPI:1720263312
Name:HEARN, WILLIAM E (CO, LPO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:HEARN
Suffix:
Gender:M
Credentials:CO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 GRAND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3418
Mailing Address - Country:US
Mailing Address - Phone:281-578-3633
Mailing Address - Fax:713-799-1260
Practice Address - Street 1:7100 GRAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3418
Practice Address - Country:US
Practice Address - Phone:713-799-1000
Practice Address - Fax:713-799-1260
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56174400000X, 224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No174400000XOther Service ProvidersSpecialist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4064690001Medicaid
TX143674304Medicaid