Individual
JOSEPH DIETRICH HEYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 8TH AVENUE, SUITE 120, FORT WORTH, TX 76104-4156
(817) 923-6900
(817) 923-6903
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 250-5485
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M9354
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204023001
—
TX
01
—
204023002
MEDICAID CSHCN
TX
01
—
P00945947
RAILROAD
TX
Enumeration date
06/06/2008
Last updated
09/30/2011
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