Provider Demographics
NPI:1629067962
Name:HEATON, DIANE M (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:HEATON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT. 18
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121
Mailing Address - Country:US
Mailing Address - Phone:918-579-8204
Mailing Address - Fax:918-579-8200
Practice Address - Street 1:1120 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4012
Practice Address - Country:US
Practice Address - Phone:918-579-8215
Practice Address - Fax:918-579-8204
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2017-02-15
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Provider Licenses
StateLicense IDTaxonomies
OK187682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK920001079OtherRAILROAD MEDICARE
OK100056850AMedicaid
OK100056850AMedicaid