Healthcare Provider Details

I. General information

NPI: 1255398061
Provider Name (Legal Business Name): DANIEL A HEIMBECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 AVENUE B
BALLINGER TX
76821-2406
US

IV. Provider business mailing address

1506 FLOYD DR
SAN ANGELO TX
76904-9009
US

V. Phone/Fax

Practice location:
  • Phone: 325-365-2531
  • Fax: 325-365-2662
Mailing address:
  • Phone: 325-212-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF8153
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF8153
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: