Provider Demographics
NPI:1699889014
Name:HESTON, TIMOTHY LOUIS (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LOUIS
Last Name:HESTON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6021 SW 29TH ST
Mailing Address - Street 2:SUITE A PMB 358
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-6200
Mailing Address - Country:US
Mailing Address - Phone:785-408-5228
Mailing Address - Fax:785-783-8026
Practice Address - Street 1:2641 SW WANAMAKER RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4969
Practice Address - Country:US
Practice Address - Phone:785-408-5228
Practice Address - Fax:785-783-8026
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS05-30776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200268430GMedicaid
KSI16751Medicare UPIN
KS200268430GMedicaid