Provider Demographics
NPI:1558599647
Name:HEAGLEY, DAWN E (DO)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:E
Last Name:HEAGLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 744326
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4326
Mailing Address - Country:US
Mailing Address - Phone:303-788-6130
Mailing Address - Fax:303-788-4996
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-788-6130
Practice Address - Fax:303-788-4996
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTEP207ZP0102X
NE6091207ZP0102X
WAOP60445070207ZP0102X
CODR.0070765207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01374517OtherRR MEDICARE
WA1558599647Medicaid
WAG8929676,G8929677Medicare PIN