Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 24093 | TX |
N | 1223G0001X | General Practice | 24093 | TX |
N | 213EG0000X | General Practice | 24093 | TX |
NPI | 1982851630 |
---|---|
Provider Name | Dr. Jarom Cooper Heaton |
First Address | Round Rock, TX 78681-1513 |
Second Address | Round Rock, TX 78681-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 10/07/2013 |