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General NPI Number Information
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NPI Number | 1013160126
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Entity Type | Individual
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Provider Name | FREDERICK EMERSON HASTY IV
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Gender | Male
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 4300 ALTON RD SUITE 1401
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2948
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Country | US
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Telephone | 305-674-2742
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Fax | 954-964-6084
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Provider Business Mailing Address
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Address Line | PO BOX 816759
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City | HOLLYWOOD
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State | FL
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Zip | 33081-0759
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Country | US
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Telephone | 954-964-2450
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Fax | 954-964-6084
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 112976
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License Number State | FL
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