Individual
MR. THOMAS J. DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
H0289
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129097501
—
TX
05
—
129097506
—
TX
01
—
1299542
UNITED HEALTHCARE
TX
01
—
2929696
CIGNA
TX
01
—
4471007
AETNA
TX
01
—
704849
MEDICARE
TX
01
—
733072
FIRST HEALTH
TX
01
—
89V970
BLUE CROSS BLUE SHIELD
TX
01
—
P02098855
MEDICARE RAIL ROAD
TX
Enumeration date
07/07/2005
Last updated
12/03/2018
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