Provider Demographics
NPI:1477534535
Name:RYTTING, HEATHER BONNIE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BONNIE
Last Name:RYTTING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RYTTING
Other - Last Name:PRASHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3603 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2646
Mailing Address - Country:US
Mailing Address - Phone:512-917-7576
Mailing Address - Fax:512-917-7576
Practice Address - Street 1:3603 BRIDLE PATH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2646
Practice Address - Country:US
Practice Address - Phone:512-917-7576
Practice Address - Fax:512-917-7576
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5627207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118297406OtherCSHCN
TX8H9285OtherBCBS OF TEXAS
TX118297405Medicaid
TX118297407Medicaid
TXP00048178Medicare PIN
TX8A1784Medicare PIN
G71963Medicare UPIN
TX118297405Medicaid