Provider Demographics
NPI:1144731464
Name:HEART HEALTH CLINIC PLLC
Entity type:Organization
Organization Name:HEART HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-908-0040
Mailing Address - Street 1:3409 RAMBLING WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7601
Mailing Address - Country:US
Mailing Address - Phone:469-908-0400
Mailing Address - Fax:469-908-0401
Practice Address - Street 1:808 WOODROW WILSON RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2061
Practice Address - Country:US
Practice Address - Phone:469-908-0400
Practice Address - Fax:469-908-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5967207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK5967OtherMEDICAL LICENSE NUMBER