Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 24746 | TX |
Y | 103TC0700X | Clinical Psychologist | 24746 | TX |
NPI | 1003910449 |
---|---|
Provider Name | Dr. Robert Warren Heffer JR. |
First Address | College Station, TX 77840-7811 |
Second Address | College Station, TX 77840-7811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 09/07/2007 |