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General NPI Number Information
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NPI Number | 1255821906
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Entity Type | Individual
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Provider Name | JOHN LOUIS HEAFNER MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 148 RICHARDSON XING
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City | ARNOLD
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State | MO
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Zip | 63010-6023
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Country | US
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Telephone | 844-853-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 4352 MANCHESTER AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2138
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Country | US
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Telephone | 314-531-5444
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2021017152
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License Number State | MO
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