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General NPI Number Information
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NPI Number | 1184708661
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Entity Type | Organization
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Legal Business Name | HAYDEL ASTHMA & ALLERGY CLINIC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 869 VERRET ST
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City | HOUMA
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State | LA
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Zip | 70360-4635
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Country | US
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Telephone | 985-868-7566
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Fax | 985-851-4778
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Provider Business Mailing Address
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Address Line | 869 VERRET ST
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City | HOUMA
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State | LA
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Zip | 70360-4635
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Country | US
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Telephone | 985-868-7566
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Fax | 985-851-4778
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Authorized Official
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Title or Position | OFFICER/DIRECTOR
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Name | DR. ROBERT DOUGLAS HAYDEL JR.
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Credential | M. D.
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Telephone | 985-868-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 019894
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License Number State | LA
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