Provider Demographics
NPI:1417001470
Name:HEALD, HAROLD D (PA)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:D
Last Name:HEALD
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1110 COTTONWOOD LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6117
Mailing Address - Country:US
Mailing Address - Phone:972-258-7499
Mailing Address - Fax:972-255-8922
Practice Address - Street 1:2400 STATE HIGHWAY 121
Practice Address - Street 2:APT 1005
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-2482
Practice Address - Country:US
Practice Address - Phone:214-629-6307
Practice Address - Fax:972-255-8922
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare UPIN