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General NPI Number Information
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NPI Number | 1942283585
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Entity Type | Individual
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Provider Name | CHARLES R HERON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 904 W TEMPLE AVE
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City | EFFINGHAM
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State | IL
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Zip | 62401
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Country | US
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Telephone | 217-342-1234
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Fax | 217-342-1230
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Provider Business Mailing Address
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Address Line | PO BOX 372
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City | MATTOON
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State | IL
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Zip | 61938-0372
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 33270-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-128867
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License Number State | IL
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