Healthcare Provider Details

I. General information

NPI: 1215086111
Provider Name (Legal Business Name): MARILYN JOY HEPPERLE M.D, FRCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 MCQUEEN SMITH RD N SUIT 302
PRATTVILLE AL
36066-7268
US

IV. Provider business mailing address

645 MCQUEEN SMITH RD N SUIT 302
PRATTVILLE AL
36066-7268
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-7404
  • Fax: 334-361-7863
Mailing address:
  • Phone: 334-361-7404
  • Fax: 334-361-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20750
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: