Healthcare Provider Details

I. General information

NPI: 1194869206
Provider Name (Legal Business Name): LARRY A. HAUSKINS, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S RYAN ST
LAKE CHARLES LA
70601-5725
US

IV. Provider business mailing address

PO BOX 3046
LAKE CHARLES LA
70602-3046
US

V. Phone/Fax

Practice location:
  • Phone: 337-491-7569
  • Fax: 337-491-7798
Mailing address:
  • Phone: 337-436-7560
  • Fax: 337-433-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number10266
License Number StateLA

VIII. Authorized Official

Name: DR. LARRY ALLEN HAUSKINS
Title or Position: OWNER
Credential: MD
Phone: 337-491-7569