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Individual

DR. CHARLES R HERON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
904 W TEMPLE AVE, EFFINGHAM, IL 62401
(217) 342-1234
(217) 342-1230
Mailing address
PO BOX 372, MATTOON, IL 61938-0372

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036-128867
IL
207L00000X
Anesthesiology Physician
33270-020
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32081000
WI
01
P0036797
RAIL ROAD MEDICARE
Enumeration date
11/29/2005
Last updated
12/13/2024
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