Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 37801 | CO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 37801 | CO |
NPI | 1881693604 |
---|---|
Provider Name | Dr. Tad Reeve Heinz |
First Address | Colorado Springs, CO 80909-1163 |
Second Address | Colorado Springs, CO 80909-1163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 20/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07551371 | (05) | CO |
F67436 | (02) | CO |