Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A115084 | CA |
NPI | 1063748911 |
---|---|
Provider Name | Chase Heaton |
First Address | San Francisco, CA 94115-3470 |
Second Address | San Francisco, CA 94115-3470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 22/05/2013 |