=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972509818
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD STEWART HAIGHT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 05/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 NEUROSCIENCE CT
-----------------------------------------------------
City | GRAY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70359-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-917-3007
-----------------------------------------------------
Fax | 985-447-4209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1930
-----------------------------------------------------
City | GRAY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70359-1930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-917-3007
-----------------------------------------------------
Fax | 985-917-3010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | MD.023100
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------