Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01064754A | IN |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | M4142 | TX |
NPI | 1053526533 |
---|---|
Provider Name | John Bradfield Heinrich |
First Address | Dallas, TX 75248-1485 |
Second Address | Dallas, TX 75243-3758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204220202 | (05) | TX |
204220203 | (05) | TX |
8AD834 | BCBS (01) | TX |