Provider Demographics
NPI:1619935962
Name:HECKRODT, STANLY BARTEN (MD, DPH)
Entity Type:Individual
Prefix:DR
First Name:STANLY
Middle Name:BARTEN
Last Name:HECKRODT
Suffix:
Gender:M
Credentials:MD, DPH
Other - Prefix:
Other - First Name:STAN
Other - Middle Name:
Other - Last Name:HECKRODT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1406 N TEXANA ST
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-2021
Mailing Address - Country:US
Mailing Address - Phone:361-798-1200
Mailing Address - Fax:361-798-4200
Practice Address - Street 1:1406 N TEXANA ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2021
Practice Address - Country:US
Practice Address - Phone:361-798-1200
Practice Address - Fax:361-798-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4330606OtherAETNA
TXP083Y0706Medicaid
TX83U07001OtherBCBS
TX83U07001OtherBCBS
TXP083Y0706Medicaid