Individual
DR. DAVID N HEVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 S WEBSTER AVE, SUITE 201, GREEN BAY, WI 54301-3500
(920) 430-7100
(920) 430-7114
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
42235
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32837700
—
WI
05
—
33320100
—
WI
01
—
364608478002
BLUE CROSS BLUE SHIELD
WI
Enumeration date
07/12/2006
Last updated
03/20/2015
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