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Individual

JOHN M HEUSINKVELD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Mailing address
PO BOX 600, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
31147
AZ
207V00000X
Obstetrics & Gynecology Physician
41276
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
49602021
CO
05
813940
AZ
05
83538577
NM
Enumeration date
12/02/2005
Last updated
06/23/2011
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