Provider Demographics
NPI:1962561282
Name:HEFNER, ALAN B (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:HEFNER
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 1:40W330 LAFOX RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6515
Mailing Address - Country:US
Mailing Address - Phone:630-584-9850
Mailing Address - Fax:630-584-1523
Practice Address - Street 1:40W330 LAFOX RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6515
Practice Address - Country:US
Practice Address - Phone:630-584-9850
Practice Address - Fax:630-584-1523
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1129551OtherUNITED HEALTHCARE
IL36047324Medicaid
IL4519570OtherBCBS
IL1129551OtherUNITED HEALTHCARE
IL4519570OtherBCBS
ILL04585Medicare ID - Type Unspecified