Provider Demographics
NPI:1568429918
Name:K GERALD HAYDEL MD APC
Entity Type:Organization
Organization Name:K GERALD HAYDEL MD APC
Other - Org Name:K. GERALD HAYDEL MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:HAYDEL
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-868-4890
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLE
Mailing Address - State:LA
Mailing Address - Zip Code:70358
Mailing Address - Country:US
Mailing Address - Phone:985-787-3585
Mailing Address - Fax:
Practice Address - Street 1:502 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4606
Practice Address - Country:US
Practice Address - Phone:985-868-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B89509Medicare UPIN
LA7474Medicare PIN