Provider Demographics
NPI:1487744645
Name:HASTINGS, PAUL RUSSELL I (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RUSSELL
Last Name:HASTINGS
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5092
Mailing Address - Country:US
Mailing Address - Phone:985-781-0015
Mailing Address - Fax:
Practice Address - Street 1:1108 CRYSTAL CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5092
Practice Address - Country:US
Practice Address - Phone:985-781-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011326OtherMEDICAL LICENSE
LA1178730Medicaid
LA1178730Medicaid
LA011326OtherMEDICAL LICENSE