Provider Demographics
NPI:1982496212
Name:VAN HEERDE, WILLIE STEPHAN (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:STEPHAN
Last Name:VAN HEERDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LINDSTROM CRESCENT
Mailing Address - Street 2:
Mailing Address - City:FORT MCMURRAY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T9K 2N7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 N. STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-674-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program