Provider Demographics
NPI:1982091088
Name:HEUERMANN, ROBERT JOHN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:HEUERMANN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-747-3258
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:DIV NEUROLOGY MOVEMENT DISORDERS, LL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-747-3258
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210272802084N0400X
MO20170183772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200060840Medicaid