Provider Demographics
NPI:1023028560
Name:HAILE, MARK EVANS
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVANS
Last Name:HAILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15790 PAUL VEGA MD DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1434
Mailing Address - Country:US
Mailing Address - Phone:985-345-2700
Mailing Address - Fax:
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-1332
Practice Address - Fax:985-230-1334
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.016204207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080119898OtherRR MEDICARE
LA1319945Medicaid
MS06221500Medicaid
5M573Medicare ID - Type Unspecified
LA1319945Medicaid