Healthcare Provider Details

I. General information

NPI: 1285804435
Provider Name (Legal Business Name): JAMES R HEERWAGEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LONG PRAIRIE RD
FLOWER MOUND TX
75028-2783
US

IV. Provider business mailing address

5000 LONG PRAIRIE RD
FLOWER MOUND TX
75028-2783
US

V. Phone/Fax

Practice location:
  • Phone: 972-420-1776
  • Fax: 972-436-6996
Mailing address:
  • Phone: 972-420-1776
  • Fax: 972-436-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberH0442
License Number StateTX

VIII. Authorized Official

Name: DR. JAMES R HEERWAGEN
Title or Position: MD
Credential: MD
Phone: 972-420-1776