Provider Demographics
NPI:1477110294
Name:MACK, HEYWARD BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:HEYWARD
Middle Name:BERNARD
Last Name:MACK
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 1:2700 NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6914
Mailing Address - Country:US
Mailing Address - Phone:504-897-5907
Mailing Address - Fax:
Practice Address - Street 1:2700 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6914
Practice Address - Country:US
Practice Address - Phone:504-897-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA335266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine