Provider Demographics
NPI:1063480333
Name:HAST, LAURIE J (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:HAST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 BLUE WISTER CV
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1367
Mailing Address - Country:US
Mailing Address - Phone:405-255-4519
Mailing Address - Fax:
Practice Address - Street 1:1208 BLUE WISTER CV
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1367
Practice Address - Country:US
Practice Address - Phone:405-255-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK196232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology