Provider Demographics
NPI:1891946232
Name:ALAN HEAP, M.D., P.C.
Entity type:Organization
Organization Name:ALAN HEAP, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HEAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-882-2207
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-0633
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:185 N MAIN ST
Practice Address - Street 2:SUITE 601
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2161
Practice Address - Country:US
Practice Address - Phone:435-882-2207
Practice Address - Fax:435-882-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171179-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1730279605Medicaid
UT1730279605Medicaid
UT000000307Medicare PIN