Provider Demographics
NPI:1225047210
Name:HECK, DAVID MATTHEW (LSA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MATTHEW
Last Name:HECK
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:STE 130, LB 11
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4418
Mailing Address - Country:US
Mailing Address - Phone:214-750-1207
Mailing Address - Fax:214-739-5029
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:STE 130, LB 11
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4418
Practice Address - Country:US
Practice Address - Phone:214-750-1207
Practice Address - Fax:214-739-5029
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00613246ZC0007X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
732OtherOPA-C NATIONAL CERT
TXAT1436OtherATHLETIC TRAINER LICENSE
069502550OtherATHLETIC TRAINER CERT
TXSA00613OtherSURGICAL ASSISTANT