Individual
DR. RANDALL LANE HELLER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6031
Mailing address
11475 OLDE CABIN RD STE 200, SAINT LOUIS, MO 63141-7129
(314) 991-8200
(314) 991-8206
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036144873
IL
2085R0202X
Diagnostic Radiology Physician
Primary
2017008012
MO
2085R0204X
Vascular & Interventional Radiology Physician
2017008012
MO
Other
Enumeration date
04/04/2011
Last updated
07/13/2020
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