Provider Demographics
NPI:1588664080
Name:HAYNIE, WILLIAM HOWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HOWARD
Last Name:HAYNIE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 51008
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-1008
Mailing Address - Country:US
Mailing Address - Phone:318-798-9400
Mailing Address - Fax:318-213-7276
Practice Address - Street 1:1453 E BERT KOUN LOOP
Practice Address - Street 2:STE 112
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6800
Practice Address - Country:US
Practice Address - Phone:318-798-9400
Practice Address - Fax:318-213-7276
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-01-30
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Provider Licenses
StateLicense IDTaxonomies
LA016837207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376418Medicaid
LA1376418Medicaid
LA53342Medicare ID - Type Unspecified