Healthcare Provider Details

I. General information

NPI: 1386683746
Provider Name (Legal Business Name): RICHARD JOHN HEDDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S LAFAYETTE AVE
SEDALIA MO
65301-7541
US

IV. Provider business mailing address

1715 S LAFAYETTE AVE
SEDALIA MO
65301-7541
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-7077
  • Fax: 660-826-4202
Mailing address:
  • Phone: 660-826-7077
  • Fax: 660-826-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2003003226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: