Healthcare Provider Details

I. General information

NPI: 1881338069
Provider Name (Legal Business Name): DAVID ANDREW HERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD STE 109N
SAINT LOUIS MO
63136-6148
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8799
  • Fax: 314-747-3368
Mailing address:
  • Phone: 314-953-8799
  • Fax: 314-747-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2022022114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: