Healthcare Provider Details

I. General information

NPI: 1962561282
Provider Name (Legal Business Name): ALAN B HEFNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40W330 LAFOX RD
ST CHARLES IL
60175-6515
US

IV. Provider business mailing address

40W330 LAFOX RD
ST CHARLES IL
60175-6515
US

V. Phone/Fax

Practice location:
  • Phone: 630-584-9850
  • Fax: 630-584-1523
Mailing address:
  • Phone: 630-584-9850
  • Fax: 630-584-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: