1679547038 NPI number — DR. BRIAN A HEISE MD

Table of content: DR. BRIAN A HEISE MD (NPI 1679547038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679547038 NPI number — DR. BRIAN A HEISE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEISE
Provider First Name:
BRIAN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679547038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 LEE DR.
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70808-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-926-4780
Provider Business Mailing Address Fax Number:
225-926-4783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 LEE DR.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-4780
Provider Business Practice Location Address Fax Number:
225-926-4783
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD.12387R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-02804 . This is a "UNITED HEALTH PLAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1429171 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5780698 . This is a "AETNA HEALTH PLAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com