Healthcare Provider Details

I. General information

NPI: 1184661076
Provider Name (Legal Business Name): DOUGLAS ALAN HEIGHTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LOCUST ST
CARTHAGE IL
62321-1459
US

IV. Provider business mailing address

630 LOCUST ST
CARTHAGE IL
62321-1459
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-2173
  • Fax: 217-357-3610
Mailing address:
  • Phone: 217-357-2173
  • Fax: 217-357-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.124727
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035..077436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: