MEDICARE: GAIL A. HEINZ PA-C

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	363AM0700X	Medical Physician Assistant	PA08036	TX

General Provider Information

NPI Number	:	1407898513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL A. HEINZ PA-C

Provider Business Mailing Address
First Line	:	202 2ND ST
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4100
Country	:	US
Telephone Number	:	956-943-1774
Fax Number	:	956-943-7938

Provider Business Practice Location Address
First Line	:	202 2ND ST
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4100
Country	:	US
Telephone Number	:	956-943-1774
Fax Number	:	956-943-7938

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/29/2016

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