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General NPI Number Information
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NPI Number | 1629398912
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Entity Type | Individual
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Provider Name | CRAIG WILLIAM HEISE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1300 N 12TH ST SUITE 605
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City | PHOENIX
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State | AZ
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Zip | 85006-2848
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Country | US
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Telephone | 602-839-2668
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Fax | 602-839-2067
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Provider Business Mailing Address
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Address Line | 1300 N 12TH ST SUITE 605
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City | PHOENIX
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State | AZ
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Zip | 85006-2848
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Country | US
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Telephone | 602-839-2668
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Fax | 602-839-2067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | 45475
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | MD221429
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | U9545
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | ME165028
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | MD221429
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 45475
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License Number State | AZ
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Taxonomy #7
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | ME165028
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | U9545
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License Number State | TX
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 45475
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License Number State | AZ
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