Provider Demographics
NPI:1730169608
Name:HEINZ, GRANT W (MD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:W
Last Name:HEINZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6007 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4801
Mailing Address - Country:US
Mailing Address - Phone:480-833-3698
Mailing Address - Fax:480-833-3735
Practice Address - Street 1:6007 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4801
Practice Address - Country:US
Practice Address - Phone:480-833-3698
Practice Address - Fax:480-833-3735
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24590207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ373720OtherAHCCCS
AZ373720OtherAHCCCS
Z66439Medicare ID - Type Unspecified