Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | M1752 | TX |
Y | 207VX0201X | Gynecologic Oncologist | M1752 | TX |
NPI | 1326148651 |
---|---|
Provider Name | Thomas Patrick Heffernan |
First Address | Fort Worth, TX 76104-4611 |
Second Address | Dallas, TX 75251-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I38120 | (02) |