Provider Demographics
NPI:1619934593
Name:HAYES, ERIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:HAYES
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 1:715 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2309
Mailing Address - Country:US
Mailing Address - Phone:337-237-7712
Mailing Address - Fax:337-232-0313
Practice Address - Street 1:715 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2309
Practice Address - Country:US
Practice Address - Phone:337-237-7712
Practice Address - Fax:337-232-0313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1901687Medicaid
LA5N131Medicare ID - Type Unspecified
LA1901687Medicaid