Provider Demographics
NPI:1902952054
Name:BRUTY, HEIDI R (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:R
Last Name:BRUTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4914
Mailing Address - Country:US
Mailing Address - Phone:214-743-6159
Mailing Address - Fax:
Practice Address - Street 1:1380 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4914
Practice Address - Country:US
Practice Address - Phone:214-743-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 914992084P0800X
TXN29662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277534400Medicaid
FL92447OtherBCBS
FLI67939Medicare UPIN
FLAA626ZMedicare PIN