Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | K0817 | TX |
N | 207RX0202X | Medical Oncology | K0817 | TX |
NPI | 1023056280 |
---|---|
Provider Name | Dr. Ralph F. Heaven |
First Address | Dallas, TX 75391-1230 |
Second Address | Abilene, TX 79601-2344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 18/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045771501 | (05) | TX |
104037001 | (05) | TX |
104037002 | (05) | TX |
8R1457 | BLUE CROSS OF TEXAS (01) | TX |
G27268 | (02) | TX |