Individual
DR. MARILYN JOY HEPPERLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D, FRCP
Contact information
Practice address
645 MCQUEEN SMITH RD N, SUIT 302, PRATTVILLE, AL 36066-7268
(334) 361-7404
(334) 361-7863
Mailing address
645 MCQUEEN SMITH RD N, SUIT 302, PRATTVILLE, AL 36066-7268
(334) 361-7404
(334) 361-7863
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20750
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000038657
—
AL
01
—
051038657HEP
BLUE CROSSBLUESHEILD
AL
01
—
110155714
RAILROAD MEDICARE
AL
01
—
4-10195
UNITED HEALTH CARE
—
01
—
582326526
TAX ID
AL
05
—
HE000038657
—
AL
Enumeration date
01/09/2007
Last updated
02/17/2010
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