Individual
JONATHAN BARRY HEISTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 8TH AVE, FORT WORTH, TX 76104-2619
(817) 820-0000
(817) 820-0097
Mailing address
800 8TH AVE, SUITE 240, FORT WORTH, TX 76104-2601
(817) 820-0000
(817) 820-0097
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
L3330
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007JD
BLUE CROSS/BLUE SHIELD
TX
01
—
108590
AMERIGROUP
TX
05
—
150089401
—
TX
01
—
158570718
PACIFICARE
TX
01
—
7569341
AETNA
TX
01
—
865822
USA MANAGED CARE
TX
Enumeration date
09/30/2005
Last updated
07/08/2007
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