Basic Information
| Provider Information | |||||||||
| NPI: | 1598742116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEATON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 N CENTRAL AVE | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850044633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207957650 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1850 N CENTRAL AVE | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850044633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207957650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | H8117 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 42713 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 123820603 | 05 | TX | MEDICAID | 123820604 | 05 | TX | MEDICAID |