MEDICARE: CHRISTOPHER DABNEY HEFFNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	036084029	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740286335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER DABNEY HEFFNER MD

Provider Business Mailing Address
First Line	:	4700 MEMORIAL DR
Second Line	:	STE 200
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5373
Country	:	US
Telephone Number	:	618-222-9192
Fax Number	:	618-222-9234

Provider Business Practice Location Address
First Line	:	4700 MEMORIAL DR
Second Line	:	STE 200
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5373
Country	:	US
Telephone Number	:	618-222-9192
Fax Number	:	618-222-9234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/20/2014

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