Provider Demographics
NPI:1053526533
Name:HEINRICH, JOHN BRADFIELD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRADFIELD
Last Name:HEINRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 676928
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6928
Mailing Address - Country:US
Mailing Address - Phone:214-265-3260
Mailing Address - Fax:972-294-3343
Practice Address - Street 1:12222 N CENTRAL EXPY STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3758
Practice Address - Country:US
Practice Address - Phone:214-265-3260
Practice Address - Fax:214-265-3261
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4142207X00000X
IN01064754A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204220202Medicaid
TX204220203Medicaid
TX8AD834OtherBCBS
TXP01114930Medicare PIN
TX204220203Medicaid
TXTXB146665Medicare PIN