Provider Demographics
NPI:1023570322
Name:HASTIE, HUSTON LEWIS
Entity Type:Individual
Prefix:
First Name:HUSTON
Middle Name:LEWIS
Last Name:HASTIE
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:ONE WYOMING ST
Mailing Address - Street 2:DEPT OF MEDICAL EDUCATION
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-2205
Mailing Address - Fax:
Practice Address - Street 1:ONE WYOMING ST
Practice Address - Street 2:DEPT OF MEDICAL EDUCATION
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program