Provider Demographics
NPI:1891780730
Name:HEGGEN, JUDITH (DO)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HEGGEN
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 4925
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-4925
Mailing Address - Country:US
Mailing Address - Phone:515-246-9620
Mailing Address - Fax:515-643-8316
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:MAIN 3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-246-9620
Practice Address - Fax:515-643-8316
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34552080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1269498Medicaid
IA13700OtherWELLMARK BLUE CROSS
IA1269498Medicaid