Provider Demographics
NPI:1417904350
Name:HEEREN, PAUL V (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:V
Last Name:HEEREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3356
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:10105 BANBURRY CROSS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6646
Practice Address - Country:US
Practice Address - Phone:702-360-7600
Practice Address - Fax:702-363-3814
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV3718207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417904350Medicaid
NVGC389Z (CQ328A)Medicare PIN
NVGC389Y (CQ328B)Medicare PIN