Basic Information
Provider Information
NPI: 1497737597
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEATH
FirstName: PAUL
MiddleName: WILLIAM
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1202 3RD ST
Address2:  
City: CORPUS CHRISTI
State: TX
PostalCode: 784042314
CountryCode: US
TelephoneNumber: 3618833962
FaxNumber: 3618836563
Practice Location
Address1: 1202 3RD ST
Address2:  
City: CORPUS CHRISTI
State: TX
PostalCode: 784042314
CountryCode: US
TelephoneNumber: 3618833962
FaxNumber: 3618836563
Other Information
ProviderEnumerationDate: 11/16/2005
LastUpdateDate: 02/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XG1913TXY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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