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Individual

KEVIN T HEATON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
2200 BRYANT WILLIAMS DRIVE, SUITE 1, KLAMATH FALLS, OR 97601-1120
(541) 884-7746
(541) 884-0848
Mailing address
2200 BRYANT WILLIAMS DRIVE, SUITE 1, KLAMATH FALLS, OR 97601-1120
(541) 884-7746
(541) 884-0848

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
DO22887
OR
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
DO22887
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
200046213
RAILROAD MEDICARE
OR
05
287483
OR
01
4604977397601
TRICARE
OR
01
831170000
BLUE CROSS
OR
01
XPY195175
MEDI-CAL
CA
Enumeration date
07/25/2006
Last updated
06/19/2024
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