Provider Demographics
NPI:1215912118
Name:HIERHOLZER, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:HIERHOLZER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:12000 HUEBNER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1209
Mailing Address - Country:US
Mailing Address - Phone:210-561-2422
Mailing Address - Fax:210-561-2466
Practice Address - Street 1:12000 HUEBNER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1209
Practice Address - Country:US
Practice Address - Phone:210-561-2422
Practice Address - Fax:210-561-2466
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2015-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL9732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1737520-01Medicaid
TX0099MTOtherBLUE CROSS BLUE SHIELD
TNI27613Medicare UPIN
TX0099MTOtherBLUE CROSS BLUE SHIELD