Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | H8118 | TX |
NPI | 1023083961 |
---|---|
Provider Name | Daragh Heitzman |
First Address | Dallas, TX 75206-5202 |
Second Address | Dallas, TX 75206-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127516605 | (05) | TX |
F74611 | (02) | TX |