Provider Demographics
NPI:1053412031
Name:HEBERLE, W KATE (MD)
Entity type:Individual
Prefix:
First Name:W
Middle Name:KATE
Last Name:HEBERLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:LESSER
Other - Last Name:HEBERLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M/D
Mailing Address - Street 1:122 RICE ML
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5415
Mailing Address - Country:US
Mailing Address - Phone:912-222-8281
Mailing Address - Fax:
Practice Address - Street 1:2301 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4720
Practice Address - Country:US
Practice Address - Phone:912-264-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21387207L00000X
GA69325207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology