Basic Information
| Provider Information | |||||||||
| NPI: | 1821207044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEFFERNAN | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722340813 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 HIGHWAY 75 NORTH | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038684700 | ||||||||
| FaxNumber: | 9038924910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N6349 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 390200000X | 0116018121 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 214144202 | 05 | TX | MEDICAID | 214144201 | 05 | TX | MEDICAID | P00942262 | 01 | TX | MEDICARE RAILROAD | OTHER | 200311330A | 01 | OK | OKAHOMA MEDICAID | OTHER |