Provider Demographics
NPI:1831877927
Name:HEUERMANN, RICHARD WILLIAM JR
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAM
Last Name:HEUERMANN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 LOGAN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3799
Mailing Address - Country:US
Mailing Address - Phone:636-279-0381
Mailing Address - Fax:
Practice Address - Street 1:6 HAIRPIN DRIVE ALUMNI HALL ROOM 2117
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-0001
Practice Address - Country:US
Practice Address - Phone:618-650-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program