Provider Demographics
NPI:1184661076
Name:HEIGHTON, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:HEIGHTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-1459
Mailing Address - Country:US
Mailing Address - Phone:217-357-2173
Mailing Address - Fax:217-357-3610
Practice Address - Street 1:630 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1459
Practice Address - Country:US
Practice Address - Phone:217-357-2173
Practice Address - Fax:217-357-3610
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124727207Q00000X
OH035..077436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0350423Medicare PIN