Basic Information
| Provider Information | |||||||||
| NPI: | 1932143922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEERENSPERGER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 FRIES RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770554721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134655347 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15775 PARK TEN PL | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770845153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816472300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | H4394 | TX | Y | Other Service Providers | Specialist |
No ID Information.