Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | G85498 | CA |
NPI | 1225147481 |
---|---|
Provider Name | Dr. William Lenox Heimer II |
First Address | Encinitas, CA 92024-5138 |
Second Address | Encinitas, CA 92024-5138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 19/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G854980 | BLUE CROSS/BLUE SHIELD (01) | |
330900346 | TRICARE (01) | |
G28434 | (02) |