Individual
GARY VAN HEUVELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1440 E MULLAN AVE, POST FALLS, ID 83854-9064
(509) 228-1000
(509) 252-9300
Mailing address
PO BOX 3868, SPOKANE, WA 99220-3868
(509) 228-1000
(509) 252-9300
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
12377C
WY
2085R0001X
Radiation Oncology Physician
Primary
M5310
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003989600
—
ID
01
—
920003975
RAILROAD MEDICARE
—
Enumeration date
08/19/2005
Last updated
10/24/2019
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