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Mr. Charles Lawson Heaton

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NPI Number Detailed Information

Provider Information:

Name: Mr. Charles Lawson Heaton
Gender: M
Provider License Number If Given: F4061

NPI Information:

NPI: 1326041377
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 3415 GOLDEN RD
Tyler, TX 75701
Phone Number: 9035260444
Fax Number: 9035262051

Provider Business Practice Location Address:

Address: 3415 GOLDEN RD
Tyler, TX 75701
Phone Number: 9035260444
Fax Number: 9035262051

Provider Taxonomy:

Primary: 207W00000X
Secondary (if any):
State: TX

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