Provider Demographics
NPI:1215086111
Name:HEPPERLE, MARILYN JOY (MD, FRCP)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:JOY
Last Name:HEPPERLE
Suffix:
Gender:F
Credentials:MD, FRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 MCQUEEN SMITH RD N
Mailing Address - Street 2:SUIT 302
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7268
Mailing Address - Country:US
Mailing Address - Phone:334-361-7404
Mailing Address - Fax:334-361-7863
Practice Address - Street 1:645 MCQUEEN SMITH RD N
Practice Address - Street 2:SUIT 302
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7268
Practice Address - Country:US
Practice Address - Phone:334-361-7404
Practice Address - Fax:334-361-7863
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL582326526OtherTAX ID
AL051038657HEPOtherBLUE CROSSBLUESHEILD
AL110155714OtherRAILROAD MEDICARE
ALHE000038657Medicaid
AL000038657Medicaid
4-10195OtherUNITED HEALTH CARE
AL582326526OtherTAX ID
AL000038657Medicare PIN
4-10195OtherUNITED HEALTH CARE