Provider Demographics
NPI:1417007642
Name:HEFFLEY, SUSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:HEFFLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:EVELYN
Other - Last Name:MORSEY HEFFLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3027 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1179
Mailing Address - Country:US
Mailing Address - Phone:719-776-4646
Mailing Address - Fax:719-776-4640
Practice Address - Street 1:3027 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1179
Practice Address - Country:US
Practice Address - Phone:719-776-4646
Practice Address - Fax:719-776-4640
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40967207Q00000X
CODR.0059357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100005270Medicaid
CO9000163357Medicaid
KY000000638818OtherANTHEM BC/BS
KYC10499OtherMEDICARE RAILROAD PTAN
CODR.0059357OtherCO MEDICAL LICENSE