Provider Demographics
NPI:1972820215
Name:HEATHMAN, JARED (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:HEATHMAN
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 1:12247 QUEENSTON BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6785
Mailing Address - Country:US
Mailing Address - Phone:281-849-4080
Mailing Address - Fax:
Practice Address - Street 1:17510 HUFFMEISTER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6785
Practice Address - Country:US
Practice Address - Phone:281-849-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP13242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP10037986OtherTEXAS MEDICAL BOARD PIT NUMBER