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General NPI Number Information
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NPI Number | 1629067962
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Entity Type | Individual
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Provider Name | DIANE M HEATON MD
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Gender | Female
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 1120 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104-4012
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Country | US
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Telephone | 918-579-8215
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Fax | 918-579-8204
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Provider Business Mailing Address
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Address Line | PO BOX 21228 DEPT. 18
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City | TULSA
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State | OK
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Zip | 74121
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Country | US
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Telephone | 918-579-8204
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Fax | 918-579-8200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 18768
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License Number State | OK
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