Provider Demographics
NPI:1750364329
Name:HEAFER, HAROLD ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ARTHUR
Last Name:HEAFER
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 1:124 CREEKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-5104
Mailing Address - Country:US
Mailing Address - Phone:972-427-8912
Mailing Address - Fax:
Practice Address - Street 1:124 CREEKVIEW LN
Practice Address - Street 2:
Practice Address - City:CRANDALL
Practice Address - State:TX
Practice Address - Zip Code:75114-5104
Practice Address - Country:US
Practice Address - Phone:972-427-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9971207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012DFOtherBCBS
TX139752311Medicaid
TX139752321Medicaid
TX8D0828Medicare PIN
TX139752321Medicaid
TX080132157Medicare PIN
TX00518GMedicare PIN