Healthcare Provider Details

I. General information

NPI: 1851330039
Provider Name (Legal Business Name): TIMOTHY ROBERT HEYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ABBOTT ST STE 101
SALINAS CA
93901-4314
US

IV. Provider business mailing address

611 ABBOTT ST STE 101
SALINAS CA
93901-4314
US

V. Phone/Fax

Practice location:
  • Phone: 831-757-3041
  • Fax: 831-757-4612
Mailing address:
  • Phone: 831-757-3041
  • Fax: 831-757-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG66100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: