Basic Information
Provider Information
NPI: 1003144593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEYBECK
FirstName: TYREEN
MiddleName: VIDAL
NamePrefix: DR.
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8 N MAIN ST STE P
Address2:  
City: KINGWOOD
State: TX
PostalCode: 773393750
CountryCode: US
TelephoneNumber: 2813607400
FaxNumber:  
Practice Location
Address1: 8 N MAIN ST STE P
Address2:  
City: KINGWOOD
State: TX
PostalCode: 773393750
CountryCode: US
TelephoneNumber: 2813607400
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/23/2009
LastUpdateDate: 08/13/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213E00000X2030TXY Podiatric Medicine & Surgery Service ProvidersPodiatrist 
213ES0103XPR175FLN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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