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General NPI Number Information
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NPI Number | 1073722872
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Entity Type | Individual
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Provider Name | DOUGLAS J HEPBURN MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 333 S KIRKWOOD RD SUITE 201
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City | KIRKWOOD
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State | MO
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Zip | 63122-6161
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Country | US
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Telephone | 314-909-0517
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Fax | 314-909-0518
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Provider Business Mailing Address
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Address Line | 833 TOWNHOUSE LN
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City | HAZELWOOD
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State | MO
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Zip | 63042-3418
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Country | US
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Telephone | 314-920-1255
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Fax | 314-909-0518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2002023837
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License Number State | MO
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