MEDICARE: DR. PAUL V HEEREN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	3718	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417904350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL V HEEREN MD

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3356
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	10105 BANBURRY CROSS DR
Second Line	:	SUITE 250
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6646
Country	:	US
Telephone Number	:	702-360-7600
Fax Number	:	702-363-3814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/07/2012

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Directions to “ DR. PAUL V HEEREN MD” Practice Location

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