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General NPI Number Information
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NPI Number | 1821087636
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Entity Type | Individual
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Provider Name | JEFFREY W. HEITKAMP M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 811 W INTERSTATE 20 UNIT G10
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City | ARLINGTON
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State | TX
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Zip | 76017-5871
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Country | US
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Telephone | 817-274-4593
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Fax | 817-274-4098
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Provider Business Mailing Address
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Address Line | PO BOX 152679
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City | ARLINGTON
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State | TX
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Zip | 76015-8679
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Country | US
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Telephone | 817-274-4593
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Fax | 817-274-4098
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | F4064
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License Number State | TX
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