Healthcare Provider Details

I. General information

NPI: 1255314191
Provider Name (Legal Business Name): WARREN HARVEY HELLER M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BUCKEYE RD SUITE 104
PHOENIX AZ
85003-3699
US

IV. Provider business mailing address

515 W BUCKEYE RD SUITE 104
PHOENIX AZ
85003-2647
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-8280
  • Fax: 602-257-7007
Mailing address:
  • Phone: 602-257-8280
  • Fax: 602-257-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8149
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number8149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: