Provider Demographics
NPI:1881702066
Name:HEYBROCK, DAMON MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:MICHAEL
Last Name:HEYBROCK
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 1:3931 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1123
Mailing Address - Country:US
Mailing Address - Phone:816-531-0415
Mailing Address - Fax:
Practice Address - Street 1:2901 ROCKCREEK PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-2536
Practice Address - Country:US
Practice Address - Phone:816-201-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine