Individual
MADIHAH HEPBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65201-5276
(573) 882-1515
(573) 884-0070
Mailing address
1 HOSPITAL DR, COLUMBIA, MO 65201-5276
(573) 882-1515
(573) 884-0070
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2015020124
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015020124
MISSOURI TEMPORARY LICENSE
MO
Enumeration date
06/26/2015
Last updated
06/26/2015
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