Healthcare Provider Details

I. General information

NPI: 1982683538
Provider Name (Legal Business Name): ROBERT W HEVEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 STATE HIGHWAY 248 STE 200
BRANSON MO
65616-8398
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 417-337-9808
  • Fax: 417-337-9827
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR5A12
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: