Healthcare Provider Details

I. General information

NPI: 1417007642
Provider Name (Legal Business Name): SUSAN M HEFFLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN EVELYN MORSEY HEFFLEY MD

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 N CIRCLE DR
COLORADO SPRINGS CO
80909-1179
US

IV. Provider business mailing address

3027 N CIRCLE DR
COLORADO SPRINGS CO
80909-1179
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-4646
  • Fax: 719-776-4640
Mailing address:
  • Phone: 719-776-4646
  • Fax: 719-776-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40967
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0059357
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: