Healthcare Provider Details

I. General information

NPI: 1033119581
Provider Name (Legal Business Name): JOHN MARK HEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 N 67TH AVE SUITE 101
GLENDALE AZ
85302-1004
US

IV. Provider business mailing address

10150 N 67TH AVE SUITE 101
GLENDALE AZ
85302-1004
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-4547
  • Fax: 632-412-4995
Mailing address:
  • Phone: 623-561-4547
  • Fax: 632-412-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7010
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: