MEDICARE: DR. PETER HEIDBRINK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	E1869	TX

General Provider Information

NPI Number	:	1124071956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER HEIDBRINK M.D.

Provider Business Mailing Address
First Line	:	221 W COLORADO BLVD STE 525
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2312
Country	:	US
Telephone Number	:	214-960-5681
Fax Number	:	214-960-5681

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD STE 525
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2312
Country	:	US
Telephone Number	:	214-960-5681
Fax Number	:	214-960-5681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/23/2024

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