Provider Demographics
NPI:1225473671
Name:HAILE, NATHAN BOYDSTON (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:BOYDSTON
Last Name:HAILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2425 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5011
Mailing Address - Country:US
Mailing Address - Phone:817-540-4477
Mailing Address - Fax:817-510-0185
Practice Address - Street 1:3301 GOLDEN TRIANGLE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-7165
Practice Address - Country:US
Practice Address - Phone:817-540-4477
Practice Address - Fax:817-540-5633
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10047226207X00000X
TXR9974207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery