Provider Demographics
NPI:1346368628
Name:HEPPE, MARK S
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:HEPPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2056
Mailing Address - Country:US
Mailing Address - Phone:406-293-9274
Mailing Address - Fax:406-293-9280
Practice Address - Street 1:214 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2056
Practice Address - Country:US
Practice Address - Phone:406-293-9274
Practice Address - Fax:406-293-9280
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine