Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2011018264 | MO |
NPI | 1023304037 |
---|---|
Provider Name | Alan D Heincker |
First Address | Rolla, MO 65401-2905 |
Second Address | Rolla, MO 65401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 23/03/2021 |