MEDICARE: DR. GLEN WAYNE HECKMAN 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	207VG0400X	Gynecology Physician	F9547	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154309656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN WAYNE HECKMAN M.D.

Provider Business Mailing Address
First Line	:	9514 MOSS HAVEN DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 GASTON AVENUE
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75246-1619
Country	:	US
Telephone Number	:	214-823-9630
Fax Number	:	214-821-3556

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	10/05/2011

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