Healthcare Provider Details

I. General information

NPI: 1104284116
Provider Name (Legal Business Name): ERIC T HEYER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE SUITE 300
ORANGE CA
92868-4231
US

IV. Provider business mailing address

1720 LOUISIANA BLVD NE SUITE 401
ALBUQUERQUE NM
87110-7022
US

V. Phone/Fax

Practice location:
  • Phone: 714-598-1745
  • Fax: 714-941-9539
Mailing address:
  • Phone: 505-260-4300
  • Fax: 505-260-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG65232
License Number StateCA

VIII. Authorized Official

Name: ERIC T HEYER
Title or Position: OWNER
Credential: MD
Phone: 505-260-4300