Organization
HEIDRICH, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN HEIDRICH MD (RESIDENT)
(206) 790-4161
Entity
Organization
Contact information
Practice address
1601 E HIGHLAND AVE APT 1138, PHOENIX, AZ 85016-4684
(206) 790-4161
Mailing address
1601 E HIGHLAND AVE APT 1138, PHOENIX, AZ 85016-4684
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
R71447
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R71447
AZ STATE LICENSE
AZ
Enumeration date
11/01/2009
Last updated
07/14/2011
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