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General NPI Number Information
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NPI Number | 1588664080
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Entity Type | Individual
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Provider Name | WILLIAM HOWARD HAYNIE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 1453 E BERT KOUN LOOP STE 112
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City | SHREVEPORT
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State | LA
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Zip | 71105-6800
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Country | US
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Telephone | 318-798-9400
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Fax | 318-213-7276
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Provider Business Mailing Address
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Address Line | PO BOX 51008
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City | SHREVEPORT
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State | LA
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Zip | 71135-1008
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Country | US
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Telephone | 318-798-9400
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Fax | 318-213-7276
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 016837
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License Number State | LA
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