Provider Demographics
NPI:1851334270
Name:HART, WILLIAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:HART
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 1:1920 WEST SALE ROAD BLDG F STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5362
Mailing Address - Country:US
Mailing Address - Phone:337-439-4014
Mailing Address - Fax:337-439-0185
Practice Address - Street 1:1920 WEST SALE ROAD BLDG F STE 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-439-4014
Practice Address - Fax:337-439-0185
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330914Medicaid
LAB63978Medicare UPIN
LA52594Medicare ID - Type Unspecified