Healthcare Provider Details

I. General information

NPI: 1235764176
Provider Name (Legal Business Name): ERIK HEGEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR. MCHE-ZSO, ORTHOPAEDIC RESIDENCY
JBSA-FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR MCHE-ZSO DEPT ORTHOPAEDICS
JBSA FT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-1284
  • Fax: 210-916-7323
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101274747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: