Healthcare Provider Details

I. General information

NPI: 1992734453
Provider Name (Legal Business Name): JOHN L HAST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BUILDING A
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

PO BOX 1919
OWENSBORO KY
42302-1919
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2273
  • Fax: 270-926-5200
Mailing address:
  • Phone: 270-926-2273
  • Fax: 270-926-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number23051
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: