Provider Demographics
NPI:1194713081
Name:HEREDIA-BEJARANO, HECTOR ORLANDO (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:ORLANDO
Last Name:HEREDIA-BEJARANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 WILKES BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4774
Mailing Address - Country:US
Mailing Address - Phone:573-815-3573
Mailing Address - Fax:573-445-7285
Practice Address - Street 1:1600 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-3573
Practice Address - Fax:573-445-7285
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004025513207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207185703Medicaid
MO207185703Medicaid
931012685Medicare PIN