Provider Demographics
NPI:1922121698
Name:HEBERLEIN, WOLF E (MD)
Entity Type:Individual
Prefix:
First Name:WOLF
Middle Name:E
Last Name:HEBERLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 E JOHNSON AVE
Mailing Address - Street 2:STE E
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1931
Mailing Address - Country:US
Mailing Address - Phone:870-932-0399
Mailing Address - Fax:870-932-0499
Practice Address - Street 1:3800 E JOHNSON AVE
Practice Address - Street 2:STE E
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1931
Practice Address - Country:US
Practice Address - Phone:870-932-0399
Practice Address - Fax:870-932-0499
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-55652085R0202X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00622537OtherRAILROAD MEDICARE
AR168510001Medicaid
AR5AB117666Medicare PIN
AR168510001Medicaid