Individual
MR. THOMAS J. DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1424 EAST FRONT, TYLER, TX 75702-8501
(903) 595-4144
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
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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