Provider Demographics
NPI:1740286335
Name:HEFFNER, CHRISTOPHER DABNEY (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DABNEY
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 1:4700 MEMORIAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5373
Mailing Address - Country:US
Mailing Address - Phone:618-222-9192
Mailing Address - Fax:618-222-9234
Practice Address - Street 1:4700 MEMORIAL DR
Practice Address - Street 2:STE 200
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5373
Practice Address - Country:US
Practice Address - Phone:618-222-9192
Practice Address - Fax:618-222-9234
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084029207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084029Medicaid
ILIL3521028Medicare PIN
ILF31175Medicare UPIN