Provider Demographics
NPI:1982830907
Name:HEFFNER, STEVEN MILLER (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MILLER
Last Name:HEFFNER
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:PO BOX 7386
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27109-6233
Mailing Address - Country:US
Mailing Address - Phone:336-758-5218
Mailing Address - Fax:336-758-6054
Practice Address - Street 1:1834 WAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27109-6000
Practice Address - Country:US
Practice Address - Phone:336-758-5218
Practice Address - Fax:336-758-6054
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921118Medicaid
NC5921118Medicaid