Individual
JACK WILLIAM HEIDENREICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 ACADIA DRIVE, RACELAND, LA 70394-2619
(985) 537-7575
(985) 537-7584
Mailing address
111 ACADIA DRIVE, RACELAND, LA 70394-2619
(985) 537-7575
(985) 537-7584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.020478
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02635262
—
MS
01
—
080192843
RR MEDICARE
LA
05
—
1901407
—
LA
Enumeration date
07/06/2005
Last updated
08/23/2010
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