Basic Information
| Provider Information | |||||||||
| NPI: | 1497756639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEBLE | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7780 S BROADWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037955980 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7780 S BROADWAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037955980 | ||||||||
| FaxNumber: | 3037957881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28217 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080146386 | 01 | CO | MEDICARERR | OTHER | 01282177 | 05 | CO | MEDICAID |