Organization
JACOB S. HEYDEMANN M.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB S. HEYDEMANN M.D. (PRESIDENT)
(915) 838-3888
Entity
Organization
Contact information
Practice address
1300 MURCHISON DR, STE 310, EL PASO, TX 79902-4842
(915) 838-3888
(915) 838-3889
Mailing address
1300 MURCHISON DR, STE 310, EL PASO, TX 79902-4842
(915) 838-3888
(915) 838-3889
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
F4077
TX
208000000X
Pediatrics Physician
F4077
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0071KQ
BCBS PROVIDER
TX
Enumeration date
03/24/2006
Last updated
03/06/2008
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