MEDICARE: DIANE M HEATON 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	2085R0203X	Therapeutic Radiology Physician	18768	OK
2	2085R0001X	Radiation Oncology Physician	18768	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	920001079	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1629067962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M HEATON MD

Provider Business Mailing Address
First Line	:	PO BOX 21228
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74121-1228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 S UTICA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4012
Country	:	US
Telephone Number	:	918-774-2071
Fax Number	:	918-579-8204

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	04/02/2026

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Directions to “ DIANE M HEATON MD” Practice Location

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