Provider Demographics
NPI:1164566394
Name:HEBAN, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HEBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5969 E BROAD ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1546
Mailing Address - Country:US
Mailing Address - Phone:614-234-7090
Mailing Address - Fax:
Practice Address - Street 1:5969 E BROAD ST
Practice Address - Street 2:SUITE 307
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:614-234-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA80104Medicare UPIN