MEDICARE: DR. JON E HEINE M.D.

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
1	207RC0000X	Cardiovascular Disease Physician	F1052	TX
2	207RI0011X	Interventional Cardiology Physician	F1052	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060012329	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	74193943977014A001	OTHER	TX	CHAMPUS
4	870932	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992707012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON E HEINE M.D.

Provider Business Mailing Address
First Line	:	925 GESSNER RD
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77024-2545
Country	:	US
Telephone Number	:	713-467-0605
Fax Number	:	713-467-3771

Provider Business Practice Location Address
First Line	:	925 GESSNER RD
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77024-2545
Country	:	US
Telephone Number	:	713-467-0605
Fax Number	:	713-467-3771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/25/2015

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Directions to “ DR. JON E HEINE M.D.” Practice Location

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