Provider Demographics
NPI:1326141920
Name:HAYAT, LIAQAT (MD)
Entity Type:Individual
Prefix:
First Name:LIAQAT
Middle Name:
Last Name:HAYAT
Suffix:
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:PO BOX 1317
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-6117
Mailing Address - Country:US
Mailing Address - Phone:850-522-0182
Mailing Address - Fax:850-522-0184
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:103
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-522-1082
Practice Address - Fax:850-522-0184
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277069500Medicaid
FLAB065ZMedicare ID - Type Unspecified
H63442Medicare UPIN