Healthcare Provider Details

I. General information

NPI: 1639779341
Provider Name (Legal Business Name): ANDREW HECHT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 TESSON FERRY RD STE 105
SAINT LOUIS MO
63128-3887
US

IV. Provider business mailing address

353 CONSORT DR
BALLWIN MO
63011-4439
US

V. Phone/Fax

Practice location:
  • Phone: 314-756-8035
  • Fax: 314-756-8050
Mailing address:
  • Phone: 636-386-9224
  • Fax: 636-200-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2020030528
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: