Healthcare Provider Details

I. General information

NPI: 1215020516
Provider Name (Legal Business Name): CLIFFORD W HEINRICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E HIGHLAND AVENUE #105
PHOENIX AZ
85016-4833
US

IV. Provider business mailing address

3031 W NORTHERN AVENUE SUITE 111
PHOENIX AZ
85051-6695
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-1502
  • Fax: 602-954-1504
Mailing address:
  • Phone: 602-347-0873
  • Fax: 602-246-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3295
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: