Provider Demographics
NPI:1568675700
Name:JOHN HEINE M.D. & MARK AVON M.D. PTRS
Entity type:Organization
Organization Name:JOHN HEINE M.D. & MARK AVON M.D. PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-793-3505
Mailing Address - Street 1:1999 MOWRY AVE STE 2M
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1706
Mailing Address - Country:US
Mailing Address - Phone:510-793-3505
Mailing Address - Fax:510-793-4799
Practice Address - Street 1:1999 MOWRY AVE STE 2M
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1706
Practice Address - Country:US
Practice Address - Phone:510-793-3505
Practice Address - Fax:510-793-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty