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General NPI Number Information
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NPI Number | 1215086111
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Entity Type | Individual
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Provider Name | MARILYN JOY HEPPERLE M.D, FRCP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 645 MCQUEEN SMITH RD N SUIT 302
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City | PRATTVILLE
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State | AL
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Zip | 36066-7268
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Country | US
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Telephone | 334-361-7404
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Fax | 334-361-7863
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Provider Business Mailing Address
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Address Line | 645 MCQUEEN SMITH RD N SUIT 302
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City | PRATTVILLE
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State | AL
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Zip | 36066-7268
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Country | US
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Telephone | 334-361-7404
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Fax | 334-361-7863
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 20750
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License Number State | AL
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