Individual
MR. JOHANNES JACOBUS HEYNEKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 NEEL AVE, SOCORRO, NM 87801
(575) 835-2940
(575) 835-2216
Mailing address
200 NEEL AVE, SOCORRO, NM 87801
(575) 835-2940
(575) 835-2216
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
79-179
NM
207Q00000X
Family Medicine Physician
Primary
79-179
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00063578
—
NM
Enumeration date
04/17/2007
Last updated
07/09/2013
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