Healthcare Provider Details

I. General information

NPI: 1033173513
Provider Name (Legal Business Name): LUTHER MYRON HEGLAND JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 S CLEVELAND AVE
SIOUX FALLS SD
57103-3245
US

IV. Provider business mailing address

1821 PARKVIEW BLVD
BRANDON SD
57005-2624
US

V. Phone/Fax

Practice location:
  • Phone: 605-368-1831
  • Fax:
Mailing address:
  • Phone: 605-553-6026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5455
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: