Basic Information
| Provider Information | |||||||||
| NPI: | 1013114610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEFNER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 DON KNOTTS BLVD | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265016734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042913627 | ||||||||
| FaxNumber: | 3042848667 | ||||||||
| Practice Location | |||||||||
| Address1: | 16490 W 78TH ST | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553464300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529345332 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS015131 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2341 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.