MEDICARE: MR. DAVID MATTHEW HECK LSA

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	246ZC0007X	Surgical Assistant	SA00613	TX

General Provider Information

NPI Number	:	1225047210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID MATTHEW HECK LSA

Provider Business Mailing Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	STE 130, LB 11
City	:	DALLAS
State	:	TX
Zip	:	75231-4418
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:	214-739-5029

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	STE 130, LB 11
City	:	DALLAS
State	:	TX
Zip	:	75231-4418
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:	214-739-5029

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	09/23/2019

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