Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9915 | TX |
NPI | 1114146123 |
---|---|
Provider Name | Dr. Warner Evans Heathman |
First Address | Pasadena, TX 77504-2183 |
Second Address | Pasadena, TX 77504-2183 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 09/07/2007 |