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NPI Code Detail

MEDICARE: DR. RANDY ROBERT HEISSER MD

MEDICARE: DR. RANDY ROBERT HEISSER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician26726TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14165919OTHERTNBCBS- TN
2TN0104OTHERTNJOHN DEERE HEALTH
3F40535OTHERTNHEALTHSPRINGS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689620999
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDY ROBERT HEISSER MD
Provider Business Mailing Address
First Line : 1508 TOMBRAS AVE
Second Line :
City : EAST RIDGE
State : TN
Zip : 37412-2720
Country : US
Telephone Number : 423-867-4969
Fax Number : 423-867-4971
Provider Business Practice Location Address
First Line : 1508 TOMBRAS AVE
Second Line :
City : EAST RIDGE
State : TN
Zip : 37412-2720
Country : US
Telephone Number : 423-867-4969
Fax Number : 423-867-4971
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 04/24/2018

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Directions to “ DR. RANDY ROBERT HEISSER MD” Practice Location

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